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Organization
NACOGDOCHES MEDICAL CLINIC PLLC
Active
Organization
NACOGDOCHES MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAVITA S VYAS M.D. (OWNER)
(936) 560-2920
Entity
Organization
Contact information
Practice address
607 RUSSELL BLVD, A, NACOGDOCHES, TX 75965-1247
(936) 560-2920
(866) 861-6312
Mailing address
607 RUSSELL BLVD, A, NACOGDOCHES, TX 75965-1247
(936) 560-2920
(866) 861-6312
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079792001
—
TX
Enumeration date
05/04/2006
Last updated
01/29/2020
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