Healthcare Provider Details

I. General information

NPI: 1740924646
Provider Name (Legal Business Name): SARATH THOMAS RANJI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5390 BARKSDALE BLVD STE 200
BOSSIER CITY LA
71112-4526
US

IV. Provider business mailing address

2539 VIKING DR STE 101
BOSSIER CITY LA
71111-2165
US

V. Phone/Fax

Practice location:
  • Phone: 318-747-8100
  • Fax: 318-747-8150
Mailing address:
  • Phone: 318-747-8100
  • Fax: 318-747-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346639
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: