Healthcare Provider Details

I. General information

NPI: 1467371872
Provider Name (Legal Business Name): LEGACY 1115 TRANSPORTATION L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 FAIRMONT DR APT 213
BOWIE MD
20716-3761
US

IV. Provider business mailing address

690 FAIRMONT DR APT 213
BOWIE MD
20716-3761
US

V. Phone/Fax

Practice location:
  • Phone: 240-904-3414
  • Fax:
Mailing address:
  • Phone: 240-904-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JAMAR ROBINSON
Title or Position: OWNER/MANAGER
Credential:
Phone: 240-904-3414