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General NPI Number Information
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NPI Number | 1962774273
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Entity Type | Organization
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Legal Business Name | LEGACY INJURY CARE
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 10740 N CENTRAL EXPY
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City | DALLAS
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State | TX
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Zip | 75231-2161
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Country | US
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Telephone | 214-864-9774
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Fax |
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Provider Business Mailing Address
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Address Line | 10740 N CENTRAL EXPY
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City | DALLAS
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State | TX
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Zip | 75231-2161
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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 | CHIEF EXECUTIVE OFFICER
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Name | DR. SAM BAILEY
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Credential |
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Telephone | 214-864-9774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G8557
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License Number State | TX
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