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General NPI Number Information
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NPI Number | 1184859191
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Entity Type | Organization
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Legal Business Name | LEGACY LABS LLC
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 106 E OLD SETTLERS BLVD STE D106
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City | ROUND ROCK
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State | TX
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Zip | 78664
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Country | US
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Telephone | 512-770-1700
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Fax | 510-373-2382
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Provider Business Mailing Address
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Address Line | 106 E OLD SETTLERS BLVD STE D106
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City | ROUND ROCK
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State | TX
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Zip | 78664-2541
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Country | US
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Telephone | 512-770-1700
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Fax | 510-373-2382
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Authorized Official
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Title or Position | DIRECTOR REVENUE CYCLE
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Name | DEBRA JEFFERSON
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Credential |
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Telephone | 512-770-1698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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