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General NPI Number Information
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NPI Number | 1790608313
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Entity Type | Organization
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Legal Business Name | LEGACY INTEGRATED HEALTH LLC
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 3585 VAN TEYLINGEN DR STE G
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-4872
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Country | US
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Telephone | 719-649-9345
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Fax |
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Provider Business Mailing Address
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Address Line | 3585 VAN TEYLINGEN DR STE G
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-4872
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Country | US
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Telephone | 719-649-9345
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Fax |
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Authorized Official
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Title or Position | PROVIDER/ADMINISTRATOR
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Name | DEMETRA SERIKI
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Credential | APRN
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Telephone | 719-649-9345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 363LW0102X
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Taxonomy Name | Women's 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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number |
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License Number State |
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