Provider Demographics
NPI:1437160777
Name:NACOGDOCHES CARDIAC CENTER, P.A.
Entity Type:Organization
Organization Name:NACOGDOCHES CARDIAC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:POKALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:936-564-2099
Mailing Address - Street 1:1023 N MOUND ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4491
Mailing Address - Country:US
Mailing Address - Phone:936-564-2099
Mailing Address - Fax:936-564-2083
Practice Address - Street 1:1023 N MOUND ST
Practice Address - Street 2:SUITE K
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4491
Practice Address - Country:US
Practice Address - Phone:936-564-2099
Practice Address - Fax:936-564-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6917207R00000X
TXL05982207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179845601Medicaid