Provider Demographics
NPI:1942265194
Name:NACOGDOCHES NEUROSURGERY, P.A.
Entity Type:Organization
Organization Name:NACOGDOCHES NEUROSURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-560-6999
Mailing Address - Street 1:5500 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1372
Mailing Address - Country:US
Mailing Address - Phone:936-560-6999
Mailing Address - Fax:936-560-9139
Practice Address - Street 1:5500 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1372
Practice Address - Country:US
Practice Address - Phone:936-560-6999
Practice Address - Fax:936-560-9139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ8921OtherPALMETTO GBA - RAILROAD MEDICARE
TXMDK8445OtherWORKERS COMPENSATION
TX0096DQOtherBLUE CROSS
TX080356101Medicaid
TX00318NMedicare PIN
TXMDK8445OtherWORKERS COMPENSATION