Provider Demographics
NPI:1164724621
Name:LEGACY PHYSICIANS GROUP, LLC
Entity Type:Organization
Organization Name:LEGACY PHYSICIANS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:LAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-668-5400
Mailing Address - Street 1:PO BOX 2306
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0042
Mailing Address - Country:US
Mailing Address - Phone:972-668-5400
Mailing Address - Fax:972-668-5401
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:972-668-5400
Practice Address - Fax:972-668-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB102731Medicare PIN