NPIMap

Organization Active NPI

Legacy Medical Clinic With Mental Health, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Temple Hills, MD
National Provider Identifier
1174388771
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
LEGACY MEDICAL CLINIC WITH MENTAL HEALTH, LLC
Practice address
4700 Stamp Rd Ste K
Temple Hills, MD 20748-6717
Phone
(301) 880-4900
NPI assigned
Feb 14, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chuks Nwaulu
Title
Owner
Phone
(240) 422-0687

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

4700 Stamp Rd Ste K
Temple Hills, MD 20748-6717

Mailing address

9509 Manor Oaks VW
Upper Marlboro, MD 20772-3192

Other practice location 1

1203 West St
Annapolis, MD 21401-3662
Phone (410) 263-4366

National Provider Directory

National Provider Directory
Tax ID family
Legacy Medical Clinic With Mental Health LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1174388771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9509 MANOR OAKS VW",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 STAMP RD STE K",
            "city": "TEMPLE HILLS",
            "state": "MD",
            "postal_code": "207486717",
            "telephone_number": "301-880-4900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1203 West St",
            "address_purpose": "LOCATION",
            "city": "Annapolis",
            "state": "MD",
            "postal_code": "214013662",
            "country_code": "US",
            "telephone_number": "410-263-4366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEGACY MEDICAL CLINIC WITH MENTAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-14",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "NWAULU",
        "authorized_official_first_name": "CHUKS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-422-0687"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple Hills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.