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General NPI Number Information
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NPI Number | 1083462329
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Entity Type | Organization
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Legal Business Name | LEGACY MED LLC
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 10150 ALMEDA GENOA RD STE H
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City | HOUSTON
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State | TX
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Zip | 77075-2435
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Country | US
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Telephone | 346-298-1521
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Fax | 832-831-6049
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Provider Business Mailing Address
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Address Line | 1814 MYSTIC ARBOR LN
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City | HOUSTON
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State | TX
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Zip | 77077-3545
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | HOANG-ANH PHAN
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Credential |
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Telephone | 713-437-7114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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