| Nacogdoches Cardiac Center, P.a. | |
|
1023 N Mound St Suite K Nacogdoches TX 75961-4491 | |
| (936) 564-2099 | |
| (936) 564-2083 |
| Full Name | Nacogdoches Cardiac Center, P.a. |
|---|---|
| Speciality | Nuclear Medicine |
| Location | 1023 N Mound St, Nacogdoches, Texas |
| Authorized Official Name and Position | Vijaya R Pokala (PRESIDENT) |
| Authorized Official Contact | 9365642099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nacogdoches Cardiac Center, P.a. 1023 N Mound St Suite K Nacogdoches TX 75961-4491 Ph: (936) 564-2099 | Nacogdoches Cardiac Center, P.a. 1023 N Mound St Suite K Nacogdoches TX 75961-4491 Ph: (936) 564-2099 |
| NPI Number | 1437160777 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4284644535 |
|---|---|
| Medicare Enrollment ID | O20060501000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437160777 | NPI | - | NPPES |
| 179845601 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | H6917 (Texas) | Primary |
| 207UN0901X | Nuclear Medicine - Nuclear Cardiology | L05982 (Texas) | Primary |
| Provider Name | Vijaya R Pokala |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1205847522 PECOS PAC ID: 7012966047 Enrollment ID: I20060501000511 |
| Provider Name | Lisa J West |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528499233 PECOS PAC ID: 0244469195 Enrollment ID: I20140219000265 |
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