Healthcare Provider Details

I. General information

NPI: 1669858635
Provider Name (Legal Business Name): LEGACY HEALTH MANAGEMENT SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5206 MARKEL RD SUITE 102
RICHMOND VA
23230-3044
US

IV. Provider business mailing address

5206 MARKEL RD SUITE 102
RICHMOND VA
23230-3044
US

V. Phone/Fax

Practice location:
  • Phone: 804-564-2746
  • Fax:
Mailing address:
  • Phone: 804-564-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101246355
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0101246355
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101246355
License Number StateVA

VIII. Authorized Official

Name: JAMES THOMPSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-564-2746