MEDICARE: LEGACY HOME MEDICAL

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	332B00000X	Durable Medical Equipment & Medical Supplies	J16933	UT

General Provider Information

NPI Number	:	1386831873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HOME MEDICAL

Provider Business Mailing Address
First Line	:	220 W GERMANTOWN PIKE STE 250
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 S FORT LN
Second Line	:	SUITE 2-A
City	:	LAYTON
State	:	UT
Zip	:	84041-4259
Country	:	US
Telephone Number	:	801-416-0997
Fax Number	:	866-468-8194

Authorized Official
Title or Position	:	CEO
Name	:	LUKE MCGEE
Credential	:
Telephone Number	:	646-880-0473

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	02/05/2021

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