NPIMap

Organization Active NPI

Legacy Healthcare Services Inc

  • Physical Therapist
  • Knoxville, TN
National Provider Identifier
1306454558
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LEGACY HEALTHCARE SERVICES INC
Practice address
8458 Gleason Dr
Knoxville, TN 37919-5482
Phone
(316) 260-6161
NPI assigned
Jul 14, 2020
Last updated
Aug 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Authorized official

Name
Mr. William Gil Wilson Jr.
Title
Cfo
Phone
(919) 424-5080

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

8458 Gleason Dr
Knoxville, TN 37919-5482

Mailing address

110 Horizon Dr Ste 310
Raleigh, NC 27615-4926
Phone (919) 424-5080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200730000160 TN Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 2163339722 Practice locations: Knoxville, TN; Powell, TN
O20200925002518 TN Part B Supplier - Clinic/Group Practice 2163339722 Receives reassigned benefits from 87 practitioners
Practice locations: Gallatin, TN; White House, TN; Powell, TN; Mt Juliet, TN; Knoxville, TN; Jefferson Cty, TN; Hermitage, TN; Hendersonville, TN…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306454558. Details of each certification follow.

  • CCN 446727 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 446727

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LEGACY HEALTHCARE SERVICES, INC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Apr 8, 2021
Last certification
Apr 8, 2021
Ownership / control type
Voluntary Non-Profit Other Than Church
Facility address
8458 Gleason Drive
Knoxville, TN 37919

National Provider Directory

National Provider Directory
Tax ID family
Legacy Healthcare Services61 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 2

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

2255 Candies Ln NW
Cleveland, TN 37312
Phone (423) 458-1708

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Windsor Point Inc CCRCFuquay-Varina, NC, CCN 345500 Skilled nursing facility Adp of the SNF Jul 1, 2011

Practitioners & affiliated clinicians

Practitioners 93

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 93

NPI Registry JSON

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1306454558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 HORIZON DR STE 310",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276154926",
            "telephone_number": "919-424-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8458 GLEASON DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379195482",
            "telephone_number": "316-260-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-14",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GIL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "919-424-5080",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.