Provider Demographics
NPI:1750785705
Name:LEGACY NEUROLOGY & SLEEP OF NORTH TEXAS
Entity type:Organization
Organization Name:LEGACY NEUROLOGY & SLEEP OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:N
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:817-500-3407
Mailing Address - Street 1:10369 BRADSHAW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-6990
Mailing Address - Country:US
Mailing Address - Phone:817-500-3407
Mailing Address - Fax:682-730-1808
Practice Address - Street 1:10369 BRADSHAW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-6990
Practice Address - Country:US
Practice Address - Phone:817-500-3407
Practice Address - Fax:682-730-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service