Provider Demographics
NPI:1942563291
Name:LEGACY DIAGNOSTIC ASSOCIATES PLLC
Entity Type:Organization
Organization Name:LEGACY DIAGNOSTIC ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-287-3093
Mailing Address - Street 1:16131 N ELDRIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-9130
Mailing Address - Country:US
Mailing Address - Phone:281-970-5900
Mailing Address - Fax:
Practice Address - Street 1:16131 N ELDRIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377
Practice Address - Country:US
Practice Address - Phone:281-970-5900
Practice Address - Fax:844-970-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty