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General NPI Number Information
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NPI Number | 1063750669
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Entity Type | Organization
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Legal Business Name | LEGACY COMMUNITY HEALTH SERVICES, INC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 2965 HARRISON ST STE 320
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City | BEAUMONT
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State | TX
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Zip | 77702-1150
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Country | US
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Telephone | 409-899-1360
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Fax | 713-523-4897
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Provider Business Mailing Address
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Address Line | PO BOX 66308
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City | HOUSTON
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State | TX
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Zip | 77266-6308
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Country | US
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Telephone | 832-548-5076
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Fax | 713-523-4897
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KATHERINE CALDWELL
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Credential |
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Telephone | 83254855051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | H80CS07502 HRSA ID
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License Number State | TX
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