Provider Demographics
NPI:1164741377
Name:LEGACY INFUSION SERVICES, LLC
Entity Type:Organization
Organization Name:LEGACY INFUSION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, FINANCE AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERDTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-576-0262
Mailing Address - Street 1:1700 EDISON DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2729
Mailing Address - Country:US
Mailing Address - Phone:513-576-0262
Mailing Address - Fax:513-576-0379
Practice Address - Street 1:9969 CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3823
Practice Address - Country:US
Practice Address - Phone:937-384-3873
Practice Address - Fax:513-942-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X
OH0220512003336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3134101Medicaid
OH6481450001Medicare NSC