1912979030 NPI number — MR. CHAKKRIS SIRI MD

Table of content: MR. CHAKKRIS SIRI MD (NPI 1912979030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912979030 NPI number — MR. CHAKKRIS SIRI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIRI
Provider First Name:
CHAKKRIS
Provider Middle Name:
Provider Name Prefix Text:
MR.
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:
1912979030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 623
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH HILL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23970-0623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-447-7765
Provider Business Mailing Address Fax Number:
434-447-4011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 BRACEY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HILL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23970-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-447-7765
Provider Business Practice Location Address Fax Number:
434-447-4011
Provider Enumeration Date:
02/02/2006

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: 207V00000X , with the licence number:  0101031880 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2099505 . This is a "ECFMB" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6208291 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912979030 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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