MEDICARE: LEGACY MEDICAL EQUIPMENT CORPORATION

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	:	1326062050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY MEDICAL EQUIPMENT CORPORATION

Provider Business Mailing Address
First Line	:	4445 W 16TH AVE STE 403
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7191
Country	:	US
Telephone Number	:	305-825-5161
Fax Number	:	305-825-5168

Provider Business Practice Location Address
First Line	:	4445 W 16TH AVE STE 403
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7191
Country	:	US
Telephone Number	:	305-825-5161
Fax Number	:	305-825-5168

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIRTHA DE LA TORRE
Credential	:
Telephone Number	:	786-346-9795

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/22/2020

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