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NPI Code Detail

MEDICARE: LEGACY COMMUNITY HEALTH SERVICES, INC

MEDICARE: LEGACY COMMUNITY HEALTH SERVICES, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician
2261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679524961
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGACY COMMUNITY HEALTH SERVICES, INC
Provider Business Mailing Address
First Line : PO BOX 66308
Second Line :
City : HOUSTON
State : TX
Zip : 77266-6308
Country : US
Telephone Number : 832-548-5000
Fax Number : 713-559-3255
Provider Business Practice Location Address
First Line : 1415 CALIFORNIA ST
Second Line :
City : HOUSTON
State : TX
Zip : 77006-2602
Country : US
Telephone Number : 832-548-5000
Fax Number :
Authorized Official
Title or Position : COO
Name : ROBERT PALUSSEK
Credential : MD
Telephone Number : 832-548-5000
Provider Enumeration Date : 05/12/2006
Last Update Date : 01/08/2025

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Directions to “LEGACY COMMUNITY HEALTH SERVICES, INC ” Practice Location

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