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Organization
LEGACY MEDICAL LLC
Active
Organization
LEGACY MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL WILSON MBA, OTR/L (CHIEF OPERATING OFFICER)
(701) 516-4637
Entity
Organization
Contact information
Practice address
600 S 2ND ST STE 200, BISMARCK, ND 58504-5729
(701) 516-4637
(877) 651-1381
Mailing address
PO BOX 13238, GRAND FORKS, ND 58208-3238
(701) 516-4637
(877) 651-1381
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
06/26/2020
Last updated
03/03/2023
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