| Legacy Medical Group | |
|
1100 Andre St Suite 101 New Iberia LA 70563-2159 | |
| (337) 369-9309 | |
| (337) 365-8455 |
| Full Name | Legacy Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 1100 Andre St, New Iberia, Louisiana |
| Authorized Official Name and Position | Wayne D Thompson (CFO) |
| Authorized Official Contact | 9856247401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Medical Group Po Box 11539 New Iberia LA 70562-1539 Ph: (337) 369-3481 | Legacy Medical Group 1100 Andre St Suite 101 New Iberia LA 70563-2159 Ph: (337) 369-9309 |
| NPI Number | 1396911558 |
|---|---|
| Provider Enumeration Date | 05/07/2008 |
| Last Update Date | 05/23/2014 |
| Medicare PECOS PAC ID | 2668543737 |
|---|---|
| Medicare Enrollment ID | O20080617000458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396911558 | NPI | - | NPPES |
| 1321583 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208600000X | Surgery | (* (Not Available)) | Secondary |
| Provider Name | Fred M Reid |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154355287 PECOS PAC ID: 7214833060 Enrollment ID: I20031211000363 |
| Provider Name | Julio E Iglesias |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1780663476 PECOS PAC ID: 4981501053 Enrollment ID: I20031217000097 |
| Provider Name | Brenda M Mahon-deri |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1821187873 PECOS PAC ID: 0840186391 Enrollment ID: I20040223001135 |
| Provider Name | Janice A Nugent |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699748525 PECOS PAC ID: 8022905801 Enrollment ID: I20040304000645 |
| Provider Name | Faisal M Thaljeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386698462 PECOS PAC ID: 1951396647 Enrollment ID: I20040420001177 |
| Provider Name | Ugochukwu Ike |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578517652 PECOS PAC ID: 7618965732 Enrollment ID: I20040505001222 |
| Provider Name | Jorge I Tapia |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881620284 PECOS PAC ID: 1759365810 Enrollment ID: I20040616000296 |
| Provider Name | Isaac A Odudu |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780780528 PECOS PAC ID: 5991783250 Enrollment ID: I20040712001597 |
| Provider Name | Christopher L Ritter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174577902 PECOS PAC ID: 4082694435 Enrollment ID: I20040726000000 |
| Provider Name | Chukwudi B Uchendu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912959453 PECOS PAC ID: 2961464979 Enrollment ID: I20041102000485 |
| Provider Name | Stacy H Zeller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437169992 PECOS PAC ID: 5496713042 Enrollment ID: I20041229000267 |
| Provider Name | Eric C Dupree |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508805532 PECOS PAC ID: 8325945421 Enrollment ID: I20050315000121 |
| Provider Name | Ricky Hendrix |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124021381 PECOS PAC ID: 5294786281 Enrollment ID: I20050422001216 |
| Provider Name | Gregory M Savoy |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1851373872 PECOS PAC ID: 0547209876 Enrollment ID: I20050427000193 |
| Provider Name | Allen W Mcclure Iii |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801893458 PECOS PAC ID: 1052357324 Enrollment ID: I20050708000153 |
| Provider Name | Daniel Renois |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316043730 PECOS PAC ID: 6507895885 Enrollment ID: I20050808000106 |
| Provider Name | Sarah C Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811925571 PECOS PAC ID: 2567481864 Enrollment ID: I20051116000313 |
| Provider Name | Michael L Alvarez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154345544 PECOS PAC ID: 7214022771 Enrollment ID: I20070928000628 |
| Provider Name | Robert E Lahasky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922086339 PECOS PAC ID: 1456420520 Enrollment ID: I20080515000046 |
| Provider Name | Edward W Dauterive |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1538151451 PECOS PAC ID: 9133290216 Enrollment ID: I20080617000527 |
| Provider Name | Binitha Joseph |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881893139 PECOS PAC ID: 2567537798 Enrollment ID: I20080821000624 |
| Provider Name | Stephen A. Boudreaux |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649291238 PECOS PAC ID: 8022927300 Enrollment ID: I20090513000219 |
| Provider Name | David C Benson |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1093703035 PECOS PAC ID: 5193714210 Enrollment ID: I20090815000072 |
| Provider Name | Seth D Rosenzweig |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1679630628 PECOS PAC ID: 0244396554 Enrollment ID: I20090827000866 |
| Provider Name | Kevin Lasseigne |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1972713519 PECOS PAC ID: 4789750365 Enrollment ID: I20091116000480 |
| Provider Name | Clyde R Roy |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1720085699 PECOS PAC ID: 0648337493 Enrollment ID: I20100823000234 |
| Provider Name | Joe B Proctor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205129582 PECOS PAC ID: 0941456859 Enrollment ID: I20120808000902 |
Jkl Healthcare Services Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 520 N Lewis St, Suite 100, New Iberia, LA 70563 Phone: 337-367-8220 Fax: 337-367-8108 | |
Your Family Care Center Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2412 Palmland Blvd, New Iberia, LA 70563 Phone: 337-519-4740 | |
Quickmed After Hours Walk In Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 814 Jefferson Ter Ste A, New Iberia, LA 70560 Phone: 337-256-5123 Fax: 337-256-5304 | |
Just Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 S Iberia St Ste 120, New Iberia, LA 70560 Phone: 337-369-3714 | |
Advanced Medical Services Of Louisiana Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1417 Center St, New Iberia, LA 70560 Phone: 337-519-5323 | |
Fremin Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1115 Center Street, New Iberia, LA 70560 Phone: 337-364-5503 | |
Family Medicine Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2309 East Main Street, Suite 400, New Iberia, LA 70560 Phone: 337-367-0271 Fax: 337-364-6139 |