Legacy Interventional Pain Center, LLC

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

676424 Issued in TX

Legal business name

LEGACY INTERVENTIONAL PAIN CENTER, LLC

Practice address

17051 Dallas Pkwy
Ste 100
Addison, TX 75001-7109

Phone

(469) 916-0521

Fax

(972) 231-7095

NPI assigned

Jun 26, 2014

Last updated

Jun 26, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy Walls

Title

Manager

Phone

(972) 234-4740

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1649685892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 674169",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752674169",
            "telephone_number": "972-479-1115",
            "fax_number": "972-346-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17051 DALLAS PKWY",
            "address_2": "STE 100",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750017109",
            "telephone_number": "469-916-0521",
            "fax_number": "972-231-7095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY INTERVENTIONAL PAIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-26",
        "last_updated": "2014-06-26",
        "status": "A",
        "authorized_official_last_name": "WALLS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "972-234-4740"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "676424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth S Lee, PT, DPT
• Eunah Kim Lee, LPC-S
• Heidi Lee, M.D.
• Soo Yun Lee
• Hannah Lise Leflore, CF-SLP
• Jordan Leinweaver, DPT
• Emily Rose Lent
• Derek M Leverette, M.A, CCC-SLP
• John Ley, LMT
• Life Tree Counseling Center Incs

• Registered Nurse in Addison, TX
• Providers in Addison, TX by specialty
• Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.