Organization
THE HEART DOCTOR IMAGING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA G YOUNG RN (OFFICE ADMINISTRATOR)
(936) 564-2828
Entity
Organization
Contact information
Practice address
5124 NORTH ST, NACOGDOCHES, TX 75965-1368
(936) 564-2828
(936) 569-1956
Mailing address
5124 NORTH ST, NACOGDOCHES, TX 75965-1368
(936) 564-2828
(936) 569-1956
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HH1822
BCBS FACILITY ID
TX
Enumeration date
08/17/2006
Last updated
08/22/2020
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