Organization
NACOGDOCHES HEART CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PRABAHAKAR 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) 715-9135
Mailing address
1303 N MOUND ST, NACOGDOCHES, TX 75961-4030
(936) 560-1844
(936) 715-9135
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00D17C
BLUE CROSS PROVIDER #
TX
05
—
082003702
—
TX
Enumeration date
07/19/2006
Last updated
02/12/2015
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