# EAST TEXAS CARDIOVASCULAR LABS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689693830
- **Authorized official:** MR. PRABHAKAR R GUNIGANTI M.D. (OWNER)
- **Authorized official phone:** (936) 560-1844

## Contact information

- **Practice address:** 1303 N MOUND ST, NACOGDOCHES, TX 75961-4030
- **Practice address phone:** (936) 560-1844
- **Practice address fax:** (936) 715-9135
- **Mailing address:** 1303 N MOUND ST, NACOGDOCHES, TX 75961-4030
- **Mailing address phone:** (936) 560-1844
- **Mailing address fax:** (936) 715-9135

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | 008031 | TX | Yes |

## Other

- **Enumeration date:** 07/19/2006
- **Last updated:** 03/12/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 034329502 | — | TX |
| 01 | — | HH1807 | BLUE CROSS PROVIDER \# | TX |