Provider Demographics
NPI:1124774203
Name:TRUE LEGACY GROUP, LLC
Entity type:Organization
Organization Name:TRUE LEGACY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING LLC MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:N
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-591-9494
Mailing Address - Street 1:12702 TOEPPERWEIN RD STE 209
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3250
Mailing Address - Country:US
Mailing Address - Phone:210-591-9494
Mailing Address - Fax:210-957-7242
Practice Address - Street 1:12702 TOEPPERWEIN RD STE 209
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3250
Practice Address - Country:US
Practice Address - Phone:210-591-9494
Practice Address - Fax:210-957-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty