Individual ProviderSirilak HamNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7292 Fulton Dr NW, Canton, OH 44718-1525(330) 837-3095PECOS EnrollmentBased on the most recent information from CMS, provider Sirilak Ham is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1720400419Provider TypeIndividualFull NameHam, SirilakCredentialAPRN-CNPGenderFemaleSole ProprietorNoEnumeration Date1/14/2014Last Updated4/18/2022Contact InformationPractice LocationPractice Address7292 Fulton Dr NW, Canton, OH 44718-1525Phone(330) 837-3095FaxUnlisted FaxMailing LocationMailing Address7292 Fulton Dr NW, Canton, OH 44718-1525Phone(330) 837-3095FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense15559OhioProvider IdentifiersIDDescriptionIssuerID0102382DescriptionMedicaidIssuerUnlistedOhio