Healthcare Provider Details

I. General information

NPI: 1295300366
Provider Name (Legal Business Name): LEGACY VEIN CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DOWELL SPRINGS BLVD STE 100
KNOXVILLE TN
37909-2457
US

IV. Provider business mailing address

1400 DOWELL SPRINGS BLVD STE 100
KNOXVILLE TN
37909-2457
US

V. Phone/Fax

Practice location:
  • Phone: 865-437-3977
  • Fax: 865-437-3912
Mailing address:
  • Phone: 865-437-3977
  • Fax: 865-437-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GINGER REECE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 423-328-0163