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General NPI Number Information
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NPI Number | 1437033214
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Entity Type | Organization
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Legal Business Name | TEAGUE LEGACY HOLDINGS
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1101 THORPE LN STE 105-439
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City | SAN MARCOS
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State | TX
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Zip | 78666-0002
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Country | US
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Telephone | 512-796-8513
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 443
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City | FENTRESS
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State | TX
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Zip | 78622-0443
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Country | US
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Telephone | 512-796-8513
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. HELLENA LORAINE TEAGUE
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Credential |
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Telephone | 512-796-8513
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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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