MEDICARE: LEGACY ONE LOGISTICS LLC

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	:	1740176247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY ONE LOGISTICS LLC

Provider Business Mailing Address
First Line	:	34707 OCEANVIEW DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-3656
Country	:	US
Telephone Number	:	313-413-4011
Fax Number	:

Provider Business Practice Location Address
First Line	:	34707 OCEANVIEW DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-3656
Country	:	US
Telephone Number	:	313-413-4011
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIANNA C THOMAS
Credential	:
Telephone Number	:	313-413-4011

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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