Provider Demographics
NPI:1073549572
Name:SARAWADEE SITTI
Entity Type:Organization
Organization Name:SARAWADEE SITTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAWADEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SITTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-669-5956
Mailing Address - Street 1:514H S DARGAN STREET
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506
Mailing Address - Country:US
Mailing Address - Phone:843-669-5956
Mailing Address - Fax:843-669-2019
Practice Address - Street 1:514H S DARGAN STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506
Practice Address - Country:US
Practice Address - Phone:843-669-5956
Practice Address - Fax:843-669-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
SC11343207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3783Medicaid
SCD97165Medicare UPIN
SCGP3783Medicaid
SC7758Medicare PIN