Provider Demographics
NPI:1942200175
Name:EAST TEXAS HEMATOLOGY & ONCOLOGY
Entity Type:Organization
Organization Name:EAST TEXAS HEMATOLOGY & ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINNAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-637-6415
Mailing Address - Street 1:1202 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3304
Mailing Address - Country:US
Mailing Address - Phone:936-637-6415
Mailing Address - Fax:936-632-9025
Practice Address - Street 1:1202 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3304
Practice Address - Country:US
Practice Address - Phone:936-637-6415
Practice Address - Fax:936-632-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8616207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0389670001Medicare NSC
TXG14507Medicare UPIN
TXB25522Medicare UPIN
TXH85293Medicare UPIN