Provider Demographics
NPI:1891159521
Name:NACOGDOCHES CARDIOVASCULAR ASSOCIATES PA
Entity Type:Organization
Organization Name:NACOGDOCHES CARDIOVASCULAR ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANMUGAM
Authorized Official - Middle Name:
Authorized Official - Last Name:UTHAMALINGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-305-5165
Mailing Address - Street 1:1004 N MOUND ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4437
Mailing Address - Country:US
Mailing Address - Phone:936-305-5165
Mailing Address - Fax:936-238-7654
Practice Address - Street 1:1004 N MOUND ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4437
Practice Address - Country:US
Practice Address - Phone:936-305-5165
Practice Address - Fax:936-238-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty