Provider Demographics
NPI:1043514458
Name:LEGACY V MEDICAL
Entity Type:Organization
Organization Name:LEGACY V MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR. MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARCOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-674-8988
Mailing Address - Street 1:3113 WILLIE MAYS PKWY
Mailing Address - Street 2:STE.1100-B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811
Mailing Address - Country:US
Mailing Address - Phone:407-674-8988
Mailing Address - Fax:407-674-8993
Practice Address - Street 1:3113 WILLIE MAYS PKWY
Practice Address - Street 2:STE.1100-B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811
Practice Address - Country:US
Practice Address - Phone:407-947-4946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment