Provider Demographics
NPI:1578011987
Name:LEGS LLC
Entity Type:Organization
Organization Name:LEGS LLC
Other - Org Name:LOUISE EISENHOWER GALLAGHER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-276-7326
Mailing Address - Street 1:1964 HOWELL BRANCH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1042
Mailing Address - Country:US
Mailing Address - Phone:407-276-7326
Mailing Address - Fax:407-264-8261
Practice Address - Street 1:1964 HOWELL BRANCH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1042
Practice Address - Country:US
Practice Address - Phone:407-276-7326
Practice Address - Fax:407-264-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9163789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305711900Medicaid