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Organization
PINEYWOODS DIAGNOSTIC CLINIC OF EAST TEXAS PA
Active
Organization
PINEYWOODS DIAGNOSTIC CLINIC OF EAST TEXAS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAVINDER R BACHIREDDY M.D. (AUTHORIZED/DELEGATED OFFICIAL)
(936) 632-8787
Entity
Organization
Contact information
Practice address
400 W CHURCH ST, LIVINGSTON, TX 77351-3416
(936) 327-7733
(936) 327-2248
Mailing address
PO BOX 151226, LUFKIN, TX 75915-1226
(936) 632-8787
(936) 632-8832
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0022MU
BLUECROSS & BLUESHIELD
TX
05
—
176384901
—
TX
Enumeration date
11/01/2006
Last updated
07/31/2008
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