Individual ProviderSean LarsenEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address269 S Candy Ln, Cottonwood, AZ 86326-4158(928) 639-6172(928) 213-6235PECOS EnrollmentBased on the most recent information from CMS, provider Sean Larsen is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1548647472Provider TypeIndividualFull NameLarsen, SeanGenderMaleSole ProprietorNoEnumeration Date4/29/2015Last Updated9/10/2020Contact InformationPractice LocationPractice Address269 S Candy Ln, Cottonwood, AZ 86326-4158Phone(928) 639-6172Fax(928) 639-6682Mailing LocationMailing Address1200 N Beaver St, Flagstaff, AZ 86001-3118Phone(928) 213-6235Fax(928) 213-6292Provider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense008197ArizonaCode207P00000XDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense6014Oklahoma