| Legacy Primary Care | |
|
616 Cypress Creek Pkwy Ste 300 Houston TX 77090-3025 | |
| (281) 364-8787 | |
| (713) 636-9088 |
| Full Name | Legacy Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 616 Cypress Creek Pkwy Ste 300, Houston, Texas |
| Authorized Official Name and Position | Hussamaddin Al Khadour (PRESIDENT) |
| Authorized Official Contact | 2813648787 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Primary Care 616 Cypress Creek Pkwy Ste 300 Houston TX 77090-3025 Ph: (281) 364-8787 | Legacy Primary Care 616 Cypress Creek Pkwy Ste 300 Houston TX 77090-3025 Ph: (281) 364-8787 |
| NPI Number | 1528368479 |
|---|---|
| Provider Enumeration Date | 10/26/2010 |
| Last Update Date | 09/05/2024 |
| Medicare PECOS PAC ID | 8325221880 |
|---|---|
| Medicare Enrollment ID | O20110322000479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528368479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | L1257 (Texas) | Secondary |
| 207R00000X | Internal Medicine | L1257 (Texas) | Primary |
| Provider Name | Hussamaddin Al Khadour |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396730230 PECOS PAC ID: 1557373578 Enrollment ID: I20101203000885 |
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