Basic Information
| Provider Information | |||||||||
| NPI: | 1013164623 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEGACY MEDICAL CENTERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3540 WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | MC MURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153172957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249410707 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3540 WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | MC MURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153172957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249410707 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | BURNETT | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7249410707 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC009236 | PA | N | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 261QM1300X | MD451022 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.