MEDICARE: NACOGDOCHES NEUROSURGERY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ8921	OTHER		PALMETTO GBA - RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MDK8445	OTHER	TX	WORKERS COMPENSATION
3	0096DQ	OTHER	TX	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942265194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NACOGDOCHES NEUROSURGERY, P.A.

Provider Business Mailing Address
First Line	:	5500 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1372
Country	:	US
Telephone Number	:	936-560-6999
Fax Number	:	936-560-9139

Provider Business Practice Location Address
First Line	:	5500 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1372
Country	:	US
Telephone Number	:	936-560-6999
Fax Number	:	936-560-9139

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES MICHAEL RANDLE
Credential	:	M.D.
Telephone Number	:	936-560-6999

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	10/17/2011

Similar Medicare Providers

1376980649 — DR. SAMANTHA DAYAWANSA MD
Practice Location Address:

5500 NORTH ST
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75965-1372

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Practice Fax:

1457460370 — DR. JAMES MICHAEL RANDLE M.D.
Practice Location Address:

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75965-1372

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1578422648 — ATLAS PROSTHETICS & ORTHOTICS, PLLC
Practice Location Address:

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1760484968 — CASCADE NACOGDOCHES HEALTH SERVICES, LTD
Practice Location Address:

227 RUSSELL BLVD
NACOGDOCHES, TX
75965-1238

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1780688648 — DR. RANDAL N VINTHER M.D.
Practice Location Address:

409 RUSSEL BLVD , SUITE D
NACOGDOCHES, TX
75965-1248

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1366447419 — EDWIN L. FERREN
Practice Location Address:

3816 N UNIVERSITY DR
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Directions to “NACOGDOCHES NEUROSURGERY, P.A. ” Practice Location

Language	Start Address	Practice Location

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