Healthcare Provider Details

I. General information

NPI: 1982190708
Provider Name (Legal Business Name): LEGACY LIGHTS & METERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 07/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 BISSONNET ST STE E1
HOUSTON TX
77099-1395
US

IV. Provider business mailing address

12600 BISSONNET ST STE E1
HOUSTON TX
77099-1395
US

V. Phone/Fax

Practice location:
  • Phone: 713-515-2051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARK THIERRY
Title or Position: CEO
Credential:
Phone: 713-515-2051