Provider Demographics
NPI:1184299265
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:423-328-0163
Mailing Address - Street 1:328 CUMMINGS ST STE A
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3245
Mailing Address - Country:US
Mailing Address - Phone:276-477-4600
Mailing Address - Fax:423-491-8109
Practice Address - Street 1:328 CUMMINGS ST STE A
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3245
Practice Address - Country:US
Practice Address - Phone:276-477-4600
Practice Address - Fax:423-491-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty