NPIMap

Organization Active NPI

East Texas Cardiovascular Labs LLC

  • Ambulatory Surgical Clinic/Center
  • Nacogdoches, TX
National Provider Identifier
1003835265
Registry record updated Oct 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
008031 Issued in TX
Legal business name
EAST TEXAS CARDIOVASCULAR LABS LLC
Practice address
1303 N Mound St
Nacogdoches, TX 75961-4030
Phone
(936) 560-1844
Fax
(936) 564-5145
NPI assigned
Jul 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Prabhakar R Guniganti, M.D.
Title
Owner
Phone
(936) 560-1844

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 008031 TX Primary

Addresses

Primary practice location

1303 N Mound St
Nacogdoches, TX 75961-4030

Mailing address

1303 N Mound St
Nacogdoches, TX 75961-4030
Phone (936) 560-1844

Other identifiers 2

IdentifierTypeStateIssuer
HH058AOtherTXBLUE CROSS PROVIDER #
171256401MedicaidTX

Other names 1

  • NACOGDOCHES SURGICAL CENTER LTD Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1003835265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 N MOUND ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614030",
            "telephone_number": "936-560-1844",
            "fax_number": "936-564-5145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 N MOUND ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614030",
            "telephone_number": "936-560-1844",
            "fax_number": "936-564-5145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS CARDIOVASCULAR LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "GUNIGANTI",
        "authorized_official_first_name": "PRABHAKAR",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-560-1844",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "008031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "HH058A",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171256401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NACOGDOCHES SURGICAL CENTER LTD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nacogdoches, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.