Provider Demographics
NPI:1679524961
Name:LEGACY COMMUNITY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:LEGACY COMMUNITY HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:832-548-5277
Mailing Address - Street 1:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:832-548-5000
Mailing Address - Fax:713-559-3255
Practice Address - Street 1:1415 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-2602
Practice Address - Country:US
Practice Address - Phone:832-548-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080462703Medicaid
TX671835Medicare Oscar/Certification
TX741825Medicare Oscar/Certification
TX1679524961OtherMAIN FQHC CONSOLIDATED BILLING NPI
TX671836Medicare Oscar/Certification
TX671835Medicare Oscar/Certification
TX671849Medicare Oscar/Certification
TX080462703Medicaid
TX741819Medicare Oscar/Certification