Legacy Family Medicine Llc | |
1113 2nd Ave West Logan WV 25601-3309 | |
(304) 752-1900 | |
(304) 752-0188 |
Full Name | Legacy Family Medicine Llc |
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Speciality | Family Medicine |
Location | 1113 2nd Ave, West 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 |
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Legacy Family Medicine Llc 214 Hanging Rock Hwy Logan WV 25601-5102 Ph: (304) 752-1900 | Legacy Family Medicine Llc 1113 2nd Ave West Logan WV 25601-3309 Ph: (304) 752-1900 |
NPI Number | 1043967466 |
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Provider Enumeration Date | 03/05/2022 |
Last Update Date | 02/24/2025 |
Medicare PECOS PAC ID | 6406292283 |
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Medicare Enrollment ID | O20240314004120 |
Identifier | Type | State | Issuer |
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1043967466 | NPI | - | NPPES |
APRN66417 | Other | WV | FNP |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Crystal L Watkins |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790272607 PECOS PAC ID: 0648515841 Enrollment ID: I20181217000985 |
Provider Name | William Ray Watkins |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104395375 PECOS PAC ID: 5496097594 Enrollment ID: I20190419000199 |
Wv Family Medicine,inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1115 2nd Ave, West Logan, WV 25601 Phone: 304-831-0085 Fax: 304-831-0088 |