LEGACY MEDICAL LLC NPI 1619594637

NPI Information

LEGACY MEDICAL LLC is an adult medicine family medicine in Bismarck, ND. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. LEGACY MEDICAL LLC NPI is 1619594637. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

600 S 2ND ST STE 200
BISMARCK, ND
ZIP 58504-729
Phone: (701) 516-4637
Fax: (877) 651-1381

The provider's authorized official is Jill Wilson .
The authorized official title is Chief Operating Officer and has the following contact phone number (701) 516-4637.

The CLIA number assigned to this NPI record is 35D2200342 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/26/2020 and was last updated on 3/3/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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