Provider Demographics
NPI:1508579988
Name:LEGENDARY MEDICAL STAFFING LLC
Entity Type:Organization
Organization Name:LEGENDARY MEDICAL STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:865-226-9679
Mailing Address - Street 1:9080 BARBEE LN STE 104B
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-6256
Mailing Address - Country:US
Mailing Address - Phone:865-226-9679
Mailing Address - Fax:865-273-0266
Practice Address - Street 1:9080 BARBEE LN STE 104B
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-6256
Practice Address - Country:US
Practice Address - Phone:865-226-9679
Practice Address - Fax:865-273-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ078910Medicaid