Provider Demographics
NPI:1699869727
Name:LEGACY PRIMARY CARE PHYSICIANS, PC
Entity type:Organization
Organization Name:LEGACY PRIMARY CARE PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-522-4084
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-0427
Mailing Address - Country:US
Mailing Address - Phone:812-522-4084
Mailing Address - Fax:812-523-2013
Practice Address - Street 1:120 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2304
Practice Address - Country:US
Practice Address - Phone:812-522-4084
Practice Address - Fax:812-523-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200379600AMedicaid
IN200379600AMedicaid
INCK5779Medicare PIN