Organization
A PRAMOTE MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRAMOTE ANANTACHAI MD (PRESIDENT CO OWNER)
(619) 997-0166
Entity
Organization
Contact information
Practice address
404 LINCOLN DRIVE, HERRIN, IL 62948
(618) 997-0166
Mailing address
404 LINCOLN DRIVE, HERRIN, IL 62948
(618) 997-0166
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3650261
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0663336
UMWA HR FUNDS
—
01
—
102992
FBL OWCP
—
Enumeration date
11/21/2006
Last updated
08/22/2020
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