Organization
EAST TEXAS HEART & VASCULAR IMAGING LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAVINDER R BACHIREDDY M.D (PRESIDENT)
(936) 632-8787
Entity
Organization
Contact information
Practice address
310 GASLIGHT BLVD, LUFKIN, TX 75904-3133
(936) 632-8787
(936) 632-8832
Mailing address
310 GASLIGHT BLVD, LUFKIN, TX 75904-3133
(936) 632-8787
(936) 632-8832
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
293D00000X
Physiological Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048374502
—
TX
01
—
HH1819
BLUECROSS BLUESHIELD OF TEXAS
TX
Enumeration date
08/28/2006
Last updated
08/14/2008
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