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General NPI Number Information
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NPI Number | 1336753722
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Entity Type | Organization
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Legal Business Name | LEGACY OF N. FL.
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 285 SW OAKWOOD CT
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City | LAKE CITY
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State | FL
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Zip | 32024-0807
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Country | US
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Telephone | 386-623-0561
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Fax |
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Provider Business Mailing Address
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Address Line | 1468 SW MAIN BLVD STE 105-5
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City | LAKE CITY
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State | FL
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Zip | 32025-1115
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Country | US
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Telephone | 386-623-0561
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | MR. MICHAEL DUANE MINTON
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Credential |
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Telephone | 386-623-0561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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