MEDICARE: LEGACY EXPRESS TRANSPORTATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1053267047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY EXPRESS TRANSPORTATION

Provider Business Mailing Address
First Line	:	3540 SUMMER AVE STE 405
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3633
Country	:	US
Telephone Number	:	901-604-2704
Fax Number	:	901-604-2704

Provider Business Practice Location Address
First Line	:	3540 SUMMER AVE STE 405
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3633
Country	:	US
Telephone Number	:	901-604-2704
Fax Number	:	901-604-2704

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBER WILSON
Credential	:
Telephone Number	:	901-604-2704

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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Directions to “LEGACY EXPRESS TRANSPORTATION ” Practice Location

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