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General NPI Number Information
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NPI Number | 1891159521
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Entity Type | Organization
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Legal Business Name | NACOGDOCHES CARDIOVASCULAR ASSOCIATES PA
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 07/16/2016
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Provider Practice Location Address
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Address Line | 1004 N MOUND ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4437
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Country | US
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Telephone | 936-305-5165
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Fax | 936-238-7654
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Provider Business Mailing Address
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Address Line | 1004 N MOUND ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4437
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Country | US
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Telephone | 936-305-5165
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Fax | 936-238-7654
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Authorized Official
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Title or Position | OWNER
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Name | SHANMUGAM UTHAMALINGAM
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Credential | M.D.
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Telephone | 936-305-5165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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