Legacy Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

LEGACY MEDICAL SUPPLY LLC

Practice address

1616 Grand Ave Ste 105
Waukegan, IL 60085-3676

Phone

(847) 942-1385

NPI assigned

Apr 23, 2025

Organization subpart

No

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

Authorized official

Name

Cameron Andre Weatherford

Title

Managing Partner

Phone

(224) 214-3916

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1745366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1710774534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 GRAND AVE STE 105",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853676",
            "telephone_number": "847-942-1385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 GRAND AVE STE 105",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853676",
            "telephone_number": "847-942-1385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-23",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A",
        "authorized_official_last_name": "WEATHERFORD",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "ANDRE",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "224-214-3916"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Learn 9 Campus in Waukegan
• Ismael Lee Chuy, M.D.
• Jennifer Lee, RN
• Lashon Antwinette Lee
• Amber Leese
• Judith Yanciri Legorreta Hernandez
• Kelly Leiba
• Lorlyn Leonen
• Alla Lerman, O.D.
• Reggie Anne Soliman Letigio

• Durable Medical Equipment & Medical Supplies in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; 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.