Healthcare Provider Details

I. General information

NPI: 1275134595
Provider Name (Legal Business Name): LEGACY COMMUNITY HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CRENSHAW RD.
HOUSTON TX
77034-1543
US

IV. Provider business mailing address

PO BOX 66308
HOUSTON TX
77266-6308
US

V. Phone/Fax

Practice location:
  • Phone: 832-548-5000
  • Fax: 281-664-5087
Mailing address:
  • Phone: 832-548-5000
  • Fax: 713-559-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PETER PALUSSEK JR.
Title or Position: COO
Credential:
Phone: 832-548-5000