Provider Demographics
NPI:1477972933
Name:LEGACY VEIN CENTER PLLC
Entity Type:Organization
Organization Name:LEGACY VEIN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:REECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-956-2682
Mailing Address - Street 1:310 N STATE OF FRANKLIN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6063
Mailing Address - Country:US
Mailing Address - Phone:423-328-0163
Mailing Address - Fax:423-491-8109
Practice Address - Street 1:310 N STATE OF FRANKLIN RD STE 103
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6063
Practice Address - Country:US
Practice Address - Phone:423-328-0163
Practice Address - Fax:423-491-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty