Provider Demographics
NPI:1568622272
Name:LEGACY URGENT CARE, PA
Entity Type:Organization
Organization Name:LEGACY URGENT CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER, FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACEP, ABEM
Authorized Official - Phone:469-399-5000
Mailing Address - Street 1:9205 LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6750
Mailing Address - Country:US
Mailing Address - Phone:972-668-6020
Mailing Address - Fax:214-872-1075
Practice Address - Street 1:9205 LEGACY DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-6750
Practice Address - Country:US
Practice Address - Phone:972-668-6020
Practice Address - Fax:214-872-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6376850001Medicare NSC
TX0A3303Medicare PIN