Provider Demographics
NPI:1639814304
Name:PODIATRY MEDICAL SURGICAL LLC
Entity Type:Organization
Organization Name:PODIATRY MEDICAL SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEGACKI
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:276-620-4772
Mailing Address - Street 1:50 BERWICK BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8483
Mailing Address - Country:US
Mailing Address - Phone:276-620-4772
Mailing Address - Fax:
Practice Address - Street 1:50 BERWICK BLVD STE 220
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-8483
Practice Address - Country:US
Practice Address - Phone:276-620-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty