MEDICARE: MAGNOLIA LEGACY

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	:	1730016825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA LEGACY

Provider Business Mailing Address
First Line	:	2737 W WASHINGTON CENTER RD LOT 13
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1489
Country	:	US
Telephone Number	:	985-352-4215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2737 W WASHINGTON CENTER RD LOT 13
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1489
Country	:	US
Telephone Number	:	985-352-4215
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALLYSHA MARSHALL
Credential	:
Telephone Number	:	985-352-4215

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “MAGNOLIA LEGACY ” Practice Location

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