Legacy Family Medicine PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LEGACY FAMILY MEDICINE PLLC

Practice address

207 E Taliaferro St
Madill, OK 73446-3410

Phone

(580) 677-9500

NPI assigned

Jan 22, 2025

Last updated

Apr 3, 2025By 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

Bailey Buck, DONPI 1457978934

Title

Owner

Phone

(580) 677-2648

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Tax ID family

Legacy Family Medicine PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Legacy Family Medicine PLLC

  • Rural Health Clinic/Center
  • Madill, OK
  • NPI 1437002193
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bailey Camille Buck, DO

  • Family Medicine Physician
  • Durant, OK
  • NPI 1457978934
  Medicare reassignment Care Compare group NPD Authorized official
• Michael Glen Cranford, DO

  • Family Medicine Physician
  • Durant, OK
  • NPI 1528553153
  Medicare reassignment Care Compare group NPD
• Jessica D Pickens, APRN-CNP

  • Family Nurse Practitioner
  • Tishomingo, OK
  • NPI 1407257942
  Medicare reassignment Care Compare group NPD
• Tabitha Nave, APRN-CNP

  • Family Nurse Practitioner
  • Atoka, OK
  • NPI 1376068460
  Medicare reassignment NPD

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

{
    "created_epoch": "1737504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1699587139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 E TALIAFERRO ST",
            "city": "MADILL",
            "state": "OK",
            "postal_code": "734463410",
            "telephone_number": "580-677-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E TALIAFERRO ST",
            "city": "MADILL",
            "state": "OK",
            "postal_code": "734463410",
            "telephone_number": "580-677-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-22",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "BAILEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-677-2648",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Koinonia Counseling Services, Inc.
• Robert Zafar Lafleur
• Beth Lane, SLP
• Christen Lee
• Legacy Family Medicine PLLC
• Lighthouse Behavioral Wellness Centers
• Looking Up Counseling
• Looking Up Counseling
• Madill Dental Company
• Madill Family Dentistry PLLC (Storts Family Dentistry-Madill)

• Family Medicine Physician in Madill, OK
• Providers in Madill, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.