Organization
CPAT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW KULAGA MD (PRESIDENT)
(903) 593-0481
Entity
Organization
Contact information
Practice address
1726 S BECKHAM AVE, TYLER, TX 75701-4465
(903) 593-0481
(903) 592-0555
Mailing address
1726 S BECKHAM AVE, TYLER, TX 75701-4465
(903) 593-0481
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10141004
—
TX
05
—
1782302-01
—
TX
01
—
8U0910
BCBS TX
TX
01
—
8U0912
BLUE CROSS BLUE SHIELD
TX
Enumeration date
10/20/2006
Last updated
06/05/2024
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