Healthcare Provider Details

I. General information

NPI: 1699869727
Provider Name (Legal Business Name): LEGACY PRIMARY CARE PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SAINT LOUIS AVE
SEYMOUR IN
47274-2304
US

IV. Provider business mailing address

PO BOX 427
SEYMOUR IN
47274-0427
US

V. Phone/Fax

Practice location:
  • Phone: 812-522-4084
  • Fax: 812-523-2013
Mailing address:
  • Phone: 812-522-4084
  • Fax: 812-523-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSEMARY E WEIR
Title or Position: PRESIDENT
Credential: MD
Phone: 812-522-4084