1902199680 NPI number — LEGACY COMMUNITY HEALTH(CLOSED)

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902199680 NPI number — LEGACY COMMUNITY HEALTH(CLOSED)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY COMMUNITY HEALTH(CLOSED)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902199680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77266-6308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
713-523-4897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3311 RICHMOND AVE(CLOSED)
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77098-3018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-548-5000
Provider Business Practice Location Address Fax Number:
713-523-4897
Provider Enumeration Date:
05/27/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CALDWELL
Authorized Official First Name:
KATY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
713-830-3038

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)