Healthcare Provider Details

I. General information

NPI: 1073477030
Provider Name (Legal Business Name): LEGACY MEDIX GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 LAKE HOWELL RD STE 1011
MAITLAND FL
32751-5914
US

IV. Provider business mailing address

407 LAKE HOWELL RD STE 1011
MAITLAND FL
32751-5914
US

V. Phone/Fax

Practice location:
  • Phone: 707-320-5062
  • Fax:
Mailing address:
  • Phone: 707-320-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LATRICE TAYLOR
Title or Position: OWNER
Credential:
Phone: 224-247-9084