Healthcare Provider Details

I. General information

NPI: 1093728800
Provider Name (Legal Business Name): SITTILERK TRIKALSARANSUKH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7114 W HOOD PL
KENNEWICK WA
99336-6712
US

IV. Provider business mailing address

7114 W HOOD PL
KENNEWICK WA
99336-6712
US

V. Phone/Fax

Practice location:
  • Phone: 509-734-4885
  • Fax: 509-734-2576
Mailing address:
  • Phone: 509-734-4885
  • Fax: 509-734-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANE M SILVEY
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 509-734-4885