Provider Demographics
NPI:1285279158
Name:OLUCHI OZUMBA MD PA
Entity type:Organization
Organization Name:OLUCHI OZUMBA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-536-4818
Mailing Address - Street 1:752 N MAIN ST UNIT 1386
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3293
Mailing Address - Country:US
Mailing Address - Phone:844-330-0900
Mailing Address - Fax:214-594-9744
Practice Address - Street 1:601 S CLY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:844-330-0900
Practice Address - Fax:214-594-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty