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General NPI Number Information
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NPI Number | 1104511039
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Entity Type | Organization
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Legal Business Name | LEGION MEDICAL PA
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 1613 COYOTE RDG
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City | CARROLLTON
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State | TX
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Zip | 75010-3227
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Country | US
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Telephone | 719-680-9398
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 COYOTE RDG
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City | CARROLLTON
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State | TX
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Zip | 75010-3227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN KOLE
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Credential | MD
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Telephone | 773-633-3499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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