=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427313774
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES LEGMEG M.S., LAT, ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2012
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3921 WESTLAWN ST
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79102-1795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-326-2200
-----------------------------------------------------
Fax | 806-371-6042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1009 KETLER ST
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79104-3317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-206-7849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT5023
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 2000007325
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------