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Organization
CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES OF EAST TEXAS
Active
Organization
CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES OF EAST TEXAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAINE RANDALL BLAKESTAD MD (OWNER)
(936) 634-8854
Entity
Organization
Contact information
Practice address
10 MEDICAL CENTER BLVD, SUITE J, LUFKIN, TX 75904-3163
(936) 634-8854
(936) 634-2305
Mailing address
10 MEDICAL CENTER BLVD, SUITE J, LUFKIN, TX 75904-3163
(936) 634-8854
(936) 634-2305
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
OF1391
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75904A003
TRICARE
TX
01
—
88G972
BCBS OF TEXAS
TX
Enumeration date
06/09/2006
Last updated
08/22/2020
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