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Organization
VASCULAR SURGERY OF NACOGDOCHES, P.A.
Active
Organization
VASCULAR SURGERY OF NACOGDOCHES, P.A.
Active
Other names
Vascular Access Center of East Texas
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALFORD RANDEL M.D. (PRESIDENT)
(936) 568-9993
Entity
Organization
Contact information
Practice address
3618 NORTH UNIVERSITY DRIVE, NACOGDOCHES, TX 75965-2539
(936) 568-9993
(936) 568-9996
Mailing address
PO BOX 630668, NACOGDOCHES, TX 75963-0668
(936) 568-9993
(936) 568-9996
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
H6529
TX
2086S0129X
Vascular Surgery Physician
Primary
H6529
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016TY
BLUE CROSS BLUE SHIELD
TX
05
—
220035401
—
TX
05
—
220035402
—
TX
Enumeration date
08/03/2010
Last updated
09/28/2011
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