Provider Demographics
NPI:1437033214
Name:TEAGUE LEGACY HOLDINGS
Entity type:Organization
Organization Name:TEAGUE LEGACY HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HELLENA
Authorized Official - Middle Name:LORAINE
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-796-8513
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:FENTRESS
Mailing Address - State:TX
Mailing Address - Zip Code:78622-0443
Mailing Address - Country:US
Mailing Address - Phone:512-796-8513
Mailing Address - Fax:
Practice Address - Street 1:1101 THORPE LN STE 105-439
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-0002
Practice Address - Country:US
Practice Address - Phone:512-796-8513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory