| Legacy Family Medicine Llc | |
|
1808 E Aztec Ave Ste 6 Gallup NM 87301-4946 | |
| (505) 863-9374 | |
| Not Available |
| Full Name | Legacy Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1808 E Aztec Ave Ste 6, Gallup, New Mexico |
| Authorized Official Name and Position | Brett Hartline (ADMINISTRATOR) |
| Authorized Official Contact | 4804989086 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Family Medicine Llc Po Box 402 Lupton AZ 86508-1402 Ph: () - | Legacy Family Medicine Llc 1808 E Aztec Ave Ste 6 Gallup NM 87301-4946 Ph: (505) 863-9374 |
| NPI Number | 1265172399 |
|---|---|
| Provider Enumeration Date | 03/29/2022 |
| Last Update Date | 03/29/2022 |
| Medicare PECOS PAC ID | 0244619872 |
|---|---|
| Medicare Enrollment ID | O20220628001003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265172399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Caleb R Lauber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205802642 PECOS PAC ID: 9739150871 Enrollment ID: I20200413003137 |
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