| Legend Internal Medicine, Urgent Care & Diagnostic | |
|
609 Hemphill St Suite 101 Fort Worth TX 76104-4137 | |
| (817) 923-8484 | |
| (817) 923-8494 |
| Full Name | Legend Internal Medicine, Urgent Care & Diagnostic |
|---|---|
| Speciality | Clinic/Center |
| Location | 609 Hemphill St, Fort Worth, Texas |
| Authorized Official Name and Position | Fidelis K Unini (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8173012053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legend Internal Medicine, Urgent Care & Diagnostic 609 Hemphill St Suite 101 Fort Worth TX 76104-4137 Ph: (817) 923-8484 | Legend Internal Medicine, Urgent Care & Diagnostic 609 Hemphill St Suite 101 Fort Worth TX 76104-4137 Ph: (817) 923-8484 |
| NPI Number | 1619003886 |
|---|---|
| Provider Enumeration Date | 02/24/2007 |
| Last Update Date | 04/16/2014 |
| Medicare PECOS PAC ID | 3476653312 |
|---|---|
| Medicare Enrollment ID | O20070707000061 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619003886 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | M5959 (Texas) | Primary |
| Provider Name | Fidelis Kanayo Unini |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083654438 PECOS PAC ID: 5092617639 Enrollment ID: I20070707000066 |
| Provider Name | Nkiruka Unini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265677926 PECOS PAC ID: 5395802631 Enrollment ID: I20090331000540 |
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