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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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