MEDICARE: MD LOGIX PRACTICE SOLUTIONS

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	293D00000X	Physiological Laboratory
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1023584372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD LOGIX PRACTICE SOLUTIONS

Provider Business Mailing Address
First Line	:	2812 ISLAND WREN DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4938
Country	:	US
Telephone Number	:	214-704-1457
Fax Number	:

Provider Business Practice Location Address
First Line	:	2812 ISLAND WREN DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4938
Country	:	US
Telephone Number	:	214-704-1457
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COSALYN YOUNG
Credential	:
Telephone Number	:	214-704-1457

Provider Enumeration Date	:	10/14/2018
Last Update Date	:	10/14/2018

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Directions to “MD LOGIX PRACTICE SOLUTIONS ” Practice Location

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