# LEGACY FAMILY MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043967466
- **Authorized official:** WENDY WHITE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (304) 688-7027

## Contact information

- **Practice address:** 1113 2ND AVE, WEST LOGAN, WV 25601-3309
- **Practice address phone:** (304) 752-1900
- **Practice address fax:** (304) 752-0188
- **Mailing address:** 1113 2ND AVE, WEST LOGAN, WV 25601-3309
- **Mailing address phone:** (304) 752-1900
- **Mailing address fax:** (304) 752-0188

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/05/2022
- **Last updated:** 09/16/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | APRN66417 | FNP | WV |