Organization
CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES OF EAST TEXAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAINE RANDALL BLAKESTAD MD (OWNER)
(936) 634-8854
Entity
Organization
Contact information
Practice address
10 MEDICAL CENTER BLVD, SUITE J, LUFKIN, TX 75904-3163
(936) 634-8854
(936) 634-2305
Mailing address
10 MEDICAL CENTER BLVD, SUITE J, LUFKIN, TX 75904-3163
(936) 634-8854
(936) 634-2305
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
OF1391
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75904A003
TRICARE
TX
01
—
88G972
BCBS OF TEXAS
TX
Enumeration date
06/09/2006
Last updated
08/22/2020
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