Provider Demographics
NPI:1770158859
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 1:4 SHERIDAN SQ STE 102
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7435
Mailing Address - Country:US
Mailing Address - Phone:423-328-0163
Mailing Address - Fax:423-491-8109
Practice Address - Street 1:1229 FOX MEADOWS BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6925
Practice Address - Country:US
Practice Address - Phone:865-437-3977
Practice Address - Fax:865-437-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty