Organization
EAST TEXAS CARDIOVASCULAR LABS, LLC
Active
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) 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
261QR0200X
Radiology Clinic/Center
Primary
008031
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034329502
—
TX
01
—
HH1807
BLUE CROSS PROVIDER #
TX
Enumeration date
07/19/2006
Last updated
03/12/2013
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