Provider Demographics
NPI:1033638929
Name:THE CHILDREN'S CLINIC RUSK PLLC
Entity Type:Organization
Organization Name:THE CHILDREN'S CLINIC RUSK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-634-2214
Mailing Address - Street 1:205 GENE SAMFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3359
Mailing Address - Country:US
Mailing Address - Phone:936-634-2214
Mailing Address - Fax:936-634-2301
Practice Address - Street 1:205 GENE SAMFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3359
Practice Address - Country:US
Practice Address - Phone:936-634-2214
Practice Address - Fax:936-634-2301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDRENS CLINIC OF LUFKIN PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty