Organization
NACOGDOCHES NEUROSURGERY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES MICHAEL RANDLE M.D. (PRESIDENT)
(936) 560-6999
Entity
Organization
Contact information
Practice address
5500 NORTH ST, NACOGDOCHES, TX 75965-1372
(936) 560-6999
(936) 560-9139
Mailing address
5500 NORTH ST, NACOGDOCHES, TX 75965-1372
(936) 560-6999
(936) 560-9139
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0096DQ
BLUE CROSS
TX
05
—
080356101
—
TX
01
—
CJ8921
PALMETTO GBA - RAILROAD MEDICARE
—
01
—
MDK8445
WORKERS COMPENSATION
TX
Enumeration date
04/19/2006
Last updated
10/17/2011
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