Provider Demographics
NPI:1750830162
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:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ONORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-749-2248
Mailing Address - Street 1:121 S WILKE RD STE 606
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1529
Mailing Address - Country:US
Mailing Address - Phone:847-749-2248
Mailing Address - Fax:
Practice Address - Street 1:860 SUMMIT ST STE 241
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4339
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:2016-09-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)