Organization
EAST TEXAS CARDIOVASCULAR LABS LLC
Active
Other names
NACOGDOCHES SURGICAL CENTER LTD
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PRABHAKAR R GUNIGANTI M.D. (OWNER)
(936) 560-1844
Entity
Organization
Contact information
Practice address
1303 N MOUND ST, NACOGDOCHES, TX 75961-4030
(936) 560-1844
(936) 564-5145
Mailing address
1303 N MOUND ST, NACOGDOCHES, TX 75961-4030
(936) 560-1844
(936) 564-5145
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
008031
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171256401
—
TX
01
—
HH058A
BLUE CROSS PROVIDER #
TX
Enumeration date
07/19/2006
Last updated
10/31/2007
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