# LEGACY MEDICAL LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1619594637
- **Authorized official:** JILL WILSON MBA, OTR/L (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (701) 516-4637

## Contact information

- **Practice address:** 600 S 2ND ST STE 200, BISMARCK, ND 58504-5729
- **Practice address phone:** (701) 516-4637
- **Practice address fax:** (877) 651-1381
- **Mailing address:** PO BOX 13238, GRAND FORKS, ND 58208-3238
- **Mailing address phone:** (701) 516-4637
- **Mailing address fax:** (877) 651-1381

## Taxonomy

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

## Other

- **Enumeration date:** 06/26/2020
- **Last updated:** 03/03/2023