Provider Demographics
NPI:1033400254
Name:LEGACY MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:LEGACY MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCRUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-533-8408
Mailing Address - Street 1:805 MADISON ST SE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4419
Mailing Address - Country:US
Mailing Address - Phone:256-533-8408
Mailing Address - Fax:256-533-8409
Practice Address - Street 1:805 MADISON ST SE
Practice Address - Street 2:SUITE 2B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4419
Practice Address - Country:US
Practice Address - Phone:256-533-8408
Practice Address - Fax:256-533-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty