# VASCULAR SURGERY OF NACOGDOCHES, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vascular Access Center of East Texas
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033423801
- **Authorized official:** DR. MARK ALFORD RANDEL M.D. (PRESIDENT)
- **Authorized official phone:** (936) 568-9993

## Contact information

- **Practice address:** 3618 NORTH UNIVERSITY DRIVE, NACOGDOCHES, TX 75965-2539
- **Practice address phone:** (936) 568-9993
- **Practice address fax:** (936) 568-9996
- **Mailing address:** PO BOX 630668, NACOGDOCHES, TX 75963-0668
- **Mailing address phone:** (936) 568-9993
- **Mailing address fax:** (936) 568-9996

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | H6529 | TX | — |
| 2086S0129X | Vascular Surgery Physician | H6529 | TX | Yes |

## Other

- **Enumeration date:** 08/03/2010
- **Last updated:** 09/28/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0016TY | BLUE CROSS BLUE SHIELD | TX |
| 05 | — | 220035401 | — | TX |
| 05 | — | 220035402 | — | TX |