| Legacy Family Medicine Llc | |
|
214 Hanging Rock Hwy Logan WV 25601-5102 | |
| (304) 784-4495 | |
| (304) 688-9020 |
| Full Name | Legacy Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 214 Hanging Rock Hwy, Logan, West Virginia |
| Authorized Official Name and Position | Wendy White (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3046887027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Family Medicine Llc 214 Hanging Rock Hwy Logan WV 25601-5102 Ph: (304) 784-4495 | Legacy Family Medicine Llc 214 Hanging Rock Hwy Logan WV 25601-5102 Ph: (304) 784-4495 |
| NPI Number | 1043967466 |
|---|---|
| Provider Enumeration Date | 03/05/2022 |
| Last Update Date | 03/05/2022 |
| Medicare PECOS PAC ID | 6406292283 |
|---|---|
| Medicare Enrollment ID | O20240314004120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043967466 | NPI | - | NPPES |
| APRN66417 | Other | WV | FNP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Crystal L Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790272607 PECOS PAC ID: 0648515841 Enrollment ID: I20181217000985 |
| Provider Name | William Ray Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104395375 PECOS PAC ID: 5496097594 Enrollment ID: I20190419000199 |
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