MEDICARE: LEGACY MEDICAL SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1275923583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	5555 E 71ST ST
Second Line	:	SUITE 7120
City	:	TULSA
State	:	OK
Zip	:	74136-6542
Country	:	US
Telephone Number	:	918-367-6960
Fax Number	:	918-367-5278

Provider Business Practice Location Address
First Line	:	5555 E 71ST ST
Second Line	:	SUITE 7120
City	:	TULSA
State	:	OK
Zip	:	74136-6542
Country	:	US
Telephone Number	:	918-367-6960
Fax Number	:	918-367-5278

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANEE COLLINS
Credential	:
Telephone Number	:	918-367-6960

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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Directions to “LEGACY MEDICAL SUPPLY ” Practice Location

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