1306976733 NPI number — RATTAPOL SRISINROONGRUANG MD

Table of content: RATTAPOL SRISINROONGRUANG MD (NPI 1306976733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306976733 NPI number — RATTAPOL SRISINROONGRUANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SRISINROONGRUANG
Provider First Name:
RATTAPOL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306976733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
05/02/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 960160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73196-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-447-2450
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W RANDOL MILL RD
Provider Second Line Business Practice Location Address:
DEPT OF EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-548-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  C70003449 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: N4124 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00778778 . This is a "RAILROAD MCARE THRU AEMA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 204229301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8BT332 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 204229302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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