Provider Demographics
NPI:1588846794
Name:SANIT SIRIKUL, MD., INC.
Entity Type:Organization
Organization Name:SANIT SIRIKUL, MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRIKUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-992-4275
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-1050
Mailing Address - Country:US
Mailing Address - Phone:318-992-4275
Mailing Address - Fax:318-992-2825
Practice Address - Street 1:155 9TH ST STE A
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342
Practice Address - Country:US
Practice Address - Phone:318-992-4275
Practice Address - Fax:318-992-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1132292Medicaid