Legacy Community Health Services, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

LEGACY COMMUNITY HEALTH SERVICES, INC

Practice address

450 N 11TH St
Beaumont, TX 77702-1804

Phone

(832) 548-5000

Fax

(713) 523-4897

NPI assigned

Oct 23, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert L Hilliard Jr., MD

Title

Ceo

Phone

(832) 548-5277

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Federally qualified health center certification: CCN 741864

Legal name

LEGACY COMMUNITY HEALTH SERVICES, INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 28, 2014

Last certification

Oct 28, 2014

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jan 25, 1982 in TX

Enrollment address

450N 11TH St
Beaumont, TX 77702-1804

Tax ID family

Legacy Community Healthclosed77 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1043106222
  NPD tax ID
• Legacy Community Health Services, Inc

  • Clinic Pharmacy
  • Houston, TX
  • NPI 1053688838
  NPD tax ID
• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Beaumont, TX
  • NPI 1063750669
  NPD tax ID
• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1063922441
  NPD tax ID
• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1093068348
  NPD tax ID
• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Missouri City, TX
  • NPI 1154049393
  NPD tax ID
• Legacy Community Health Services, Inc

  • Community/Retail Pharmacy
  • Houston, TX
  • NPI 1154847515
  NPD tax ID
• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1174875470
  NPD tax ID
• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1194019992
  NPD tax ID
• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1245583590
  NPD tax ID
• Legacy Community Health Services, Inc

  • Pharmacy
  • Missouri City, TX
  • NPI 1255061040
  NPD tax ID
• Legacy Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1265107528
  NPD tax ID

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Allison Floyd Wells, M.D.

  • Anesthesiology Physician
  • Spring, TX
  • NPI 1528268117

  Corporate Director

  CMS ownership

All facility ownership & control disclosures 21

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1184029969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66308",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772666308",
            "telephone_number": "832-548-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N 11TH ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021804",
            "telephone_number": "832-548-5000",
            "fax_number": "713-523-4897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY COMMUNITY HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-23",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "HILLIARD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "832-548-5277",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Michelle Lee, RN
• Mercedes Lee, BCBA
• Shung Man Kurt Lee, MD
• Cheryl Marie Leemhuis, PTA
• Legacy Community Health Services, Inc
• Legacy Community Health Services, Inc
• Legacy Community Health Services, Inc
• Legacy Community Health Services, Inc
• Legacy Community Health Services, Inc
• Legacy Community Health Services, Inc.

• Federally Qualified Health Center (FQHC) in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Federally Qualified Health Center (FQHC) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.