Provider Demographics
NPI:1659152510
Name:MDMAC LOGISTICS PLLC
Entity Type:Organization
Organization Name:MDMAC LOGISTICS PLLC
Other - Org Name:RUSK HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EZENWANYI
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUCHEKWA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,FNP
Authorized Official - Phone:903-683-0559
Mailing Address - Street 1:133 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-1372
Mailing Address - Country:US
Mailing Address - Phone:903-683-0559
Mailing Address - Fax:
Practice Address - Street 1:133 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1372
Practice Address - Country:US
Practice Address - Phone:903-683-0559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty