Provider Demographics
NPI:1083290431
Name:LEGACY LAB SERVICES
Entity Type:Organization
Organization Name:LEGACY LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARLEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-880-9280
Mailing Address - Street 1:241 MCLAWS CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5861
Mailing Address - Country:US
Mailing Address - Phone:757-880-9280
Mailing Address - Fax:
Practice Address - Street 1:241 MCLAWS CIR STE 103
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5861
Practice Address - Country:US
Practice Address - Phone:757-880-9280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory