# LEGACY PRIMARY CARE PLLC

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

## Provider details

- **NPI number:** 1265277115
- **Authorized official:** HEIDI WILLIAMS (CRED SPEC)
- **Authorized official phone:** (605) 846-8239

## Contact information

- **Practice address:** 2100 S COLUMBIA RD STE 114, GRAND FORKS, ND 58201-5895
- **Practice address phone:** (701) 516-4637
- **Practice address fax:** (877) 651-1381
- **Mailing address:** 19580 SCOUT LN, SAINT ONGE, SD 57779-7913

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/01/2024
- **Last updated:** 07/01/2024