| Legacy Wellness | |
|
927 Sw D Ave Lawton OK 73501-4530 | |
| (405) 936-0504 | |
| (405) 936-0561 |
| Full Name | Legacy Wellness |
|---|---|
| Speciality | Family Medicine |
| Location | 927 Sw D Ave, Lawton, Oklahoma |
| Authorized Official Name and Position | Jennifer L Le (PROVIDER) |
| Authorized Official Contact | 4056158967 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Wellness Po Box 57390 Oklahoma City OK 73157-7390 Ph: (405) 506-9101 | Legacy Wellness 927 Sw D Ave Lawton OK 73501-4530 Ph: (405) 936-0504 |
| NPI Number | 1033989272 |
|---|---|
| Provider Enumeration Date | 01/08/2024 |
| Last Update Date | 11/18/2024 |
| Medicare PECOS PAC ID | 2769916162 |
|---|---|
| Medicare Enrollment ID | O20241107002315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033989272 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jennifer Le |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689233272 PECOS PAC ID: 1052733953 Enrollment ID: I20200623001810 |
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