Provider Demographics
NPI:1558025908
Name:LEGACY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LEGACY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-766-1902
Mailing Address - Street 1:2407 RING RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5938
Mailing Address - Country:US
Mailing Address - Phone:270-766-1902
Mailing Address - Fax:
Practice Address - Street 1:2407 RING RD STE 104
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5938
Practice Address - Country:US
Practice Address - Phone:270-766-1902
Practice Address - Fax:270-737-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty