Provider Demographics
NPI:1750516118
Name:LEGACY DURABLE MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:LEGACY DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:COOKSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-896-5937
Mailing Address - Street 1:PO BOX 7567
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-7567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8035 EASTEX FWY
Practice Address - Street 2:SUITE A
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-2420
Practice Address - Country:US
Practice Address - Phone:409-896-5937
Practice Address - Fax:409-896-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6395750001Medicare NSC