| Legacy Medical Llc | |
|
600 S 2nd St Ste 200 Bismarck ND 58504-5729 | |
| (701) 516-4637 | |
| (877) 651-1381 |
| Full Name | Legacy Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 600 S 2nd St Ste 200, Bismarck, North Dakota |
| Authorized Official Name and Position | Jill Wilson (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 7015164637 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Medical Llc Po Box 13238 Grand Forks ND 58208-3238 Ph: (701) 516-4637 | Legacy Medical Llc 600 S 2nd St Ste 200 Bismarck ND 58504-5729 Ph: (701) 516-4637 |
| NPI Number | 1619594637 |
|---|---|
| Provider Enumeration Date | 06/26/2020 |
| Last Update Date | 03/03/2023 |
| Medicare PECOS PAC ID | 0648698290 |
|---|---|
| Medicare Enrollment ID | O20200914001248 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619594637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Rebecca Kreis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164775441 PECOS PAC ID: 9335392232 Enrollment ID: I20121228000308 |
| Provider Name | Cynthia L Wald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912498593 PECOS PAC ID: 7719237932 Enrollment ID: I20180910003123 |
| Provider Name | Mckenzie Disrud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265093124 PECOS PAC ID: 4385972678 Enrollment ID: I20190823003008 |
| Provider Name | Chelsea Vollmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871154211 PECOS PAC ID: 9739418435 Enrollment ID: I20190905001406 |
| Provider Name | Tricia Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073974168 PECOS PAC ID: 1456770395 Enrollment ID: I20200928000532 |
| Provider Name | Michelle Jill Rexine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598413312 PECOS PAC ID: 4486040946 Enrollment ID: I20220408002035 |
| Provider Name | Kaitlyn Marie Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740919224 PECOS PAC ID: 4587045885 Enrollment ID: I20220718003080 |
| Provider Name | Traci Specht |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144908625 PECOS PAC ID: 0648631622 Enrollment ID: I20230808000181 |
| Provider Name | Anna Wiemken |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982433082 PECOS PAC ID: 3971034257 Enrollment ID: I20240927002228 |
| Provider Name | Jeffrey Rapp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386612653 PECOS PAC ID: 4789655267 Enrollment ID: I20241018002485 |
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