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General NPI Number Information
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NPI Number | 1437002193
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Entity Type | Organization
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Legal Business Name | LEGACY FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 207 E TALIAFERRO ST
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City | MADILL
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State | OK
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Zip | 73446-3410
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Country | US
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Telephone | 580-667-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 207 E TALIAFERRO ST
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City | MADILL
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State | OK
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Zip | 73446-3410
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Country | US
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Telephone | 580-667-9500
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | BAILEY CAMILLE BUCK
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Credential |
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Telephone | 580-677-2648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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