Provider Demographics
NPI:1497181697
Name:LEGACY MEDICAL CARE INC
Entity Type:Organization
Organization Name:LEGACY MEDICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ONORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-749-2284
Mailing Address - Street 1:121 S. WILKE RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-749-2248
Mailing Address - Fax:847-214-4912
Practice Address - Street 1:121 S. WILKE RD
Practice Address - Street 2:SUITE 600
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-749-2248
Practice Address - Fax:847-214-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)