MEDICARE: LEGEND WELLNESS CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician

General Provider Information

NPI Number	:	1063355782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGEND WELLNESS CLINIC INC

Provider Business Mailing Address
First Line	:	1919 NORTH LOOP W STE 280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1368
Country	:	US
Telephone Number	:	832-446-9371
Fax Number	:	932-446-4797

Provider Business Practice Location Address
First Line	:	1919 NORTH LOOP W STE 280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1368
Country	:	US
Telephone Number	:	832-446-9371
Fax Number	:	932-446-4797

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRINCE ANDREWS
Credential	:	JD
Telephone Number	:	346-735-5253

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “LEGEND WELLNESS CLINIC INC ” Practice Location

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