Provider Demographics
NPI:1437237583
Name:LEGACY OXYGEN & HOME CARE EQUIPMENT, LLC
Entity Type:Organization
Organization Name:LEGACY OXYGEN & HOME CARE EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-441-8876
Mailing Address - Street 1:800 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6808
Mailing Address - Country:US
Mailing Address - Phone:270-442-7887
Mailing Address - Fax:270-442-7897
Practice Address - Street 1:800 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6808
Practice Address - Country:US
Practice Address - Phone:270-442-7887
Practice Address - Fax:270-442-7897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYNG0539OtherBOARD OF PHARMACY
KY5554240001Medicare NSC