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General NPI Number Information
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NPI Number | 1750570008
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Entity Type | Organization
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Legal Business Name | PICKETT HEART CLINIC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 1111 W FRANK AVE SUITE 203
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City | LUFKIN
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State | TX
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Zip | 75904-3303
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Country | US
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Telephone | 936-634-9844
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Fax | 936-634-9258
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Provider Business Mailing Address
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Address Line | 1111 W FRANK AVE SUITE 203
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City | LUFKIN
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State | TX
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Zip | 75904-3303
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Country | US
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Telephone | 936-634-9844
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Fax | 936-634-9258
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | BRIAN R PICKETT
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Credential | MD
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Telephone | 936-634-9844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | E8818
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License Number State | TX
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