Provider Demographics
NPI:1093452229
Name:MACIE MEDICAL
Entity Type:Organization
Organization Name:MACIE MEDICAL
Other - Org Name:MACIE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIEKWENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-300-3905
Mailing Address - Street 1:777 S FRY RD STE 206
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2297
Mailing Address - Country:US
Mailing Address - Phone:713-300-3905
Mailing Address - Fax:713-561-3890
Practice Address - Street 1:777 S FRY RD STE 206
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2297
Practice Address - Country:US
Practice Address - Phone:713-300-3905
Practice Address - Fax:713-561-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center