Provider Demographics
NPI:1750017281
Name:LEGENDS ENTERPRISE LLC
Entity type:Organization
Organization Name:LEGENDS ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-880-8819
Mailing Address - Street 1:2310 OVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-4730
Mailing Address - Country:US
Mailing Address - Phone:601-880-8819
Mailing Address - Fax:
Practice Address - Street 1:2310 OVERBROOK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-4730
Practice Address - Country:US
Practice Address - Phone:601-880-8819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGENDS ENTERPRISE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company