Active NPI
Watanachai Sujatanond
- Surgery Physician
- Herrin, IL
National Provider Identifier
1548344997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Practice address
- 201 South 14TH Street
Herrin, IL 62948 - Phone
- (618) 942-4363
- Fax
- (618) 942-8573
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | IL | Primary |
Addresses
Primary practice location
201 South 14TH Street
Herrin, IL 62948
Mailing address
Post Office Box 548
Herrin, IL 62948
Phone (618) 942-4363
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10000129 | Other | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036046357 | IL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1548344997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "POST OFFICE BOX 548",
"city": "HERRIN",
"state": "IL",
"postal_code": "62948",
"telephone_number": "618-942-4363",
"fax_number": "618-942-8573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 SOUTH 14TH STREET",
"city": "HERRIN",
"state": "IL",
"postal_code": "62948",
"telephone_number": "618-942-4363",
"fax_number": "618-942-8573"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUJATANOND",
"first_name": "WATANACHAI",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "10000129",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Herrin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.