NPIMap

Organization Active NPI

Legacy Healthcare Services Inc

  • Physical Therapist
  • Roanoke, VA
National Provider Identifier
1740820828
Registry record updated Jan 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LEGACY HEALTHCARE SERVICES INC
Practice address
3365 Ogden Rd
Roanoke, VA 24018-1151
Phone
(540) 682-7506
NPI assigned
Jan 7, 2020
Last updated
Jan 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2020

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

Authorized official

Name
William G Wilson Jr.
Title
Chief Financial Officer
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

3365 Ogden Rd
Roanoke, VA 24018-1151

Mailing address

3001 Spring Forest Rd Ste 101
Raleigh, NC 27616-2816
Phone (919) 424-4312

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200313002051 VA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2163339722 Receives reassigned benefits from 109 practitioners
Practice locations: Yorktown, VA; Williamsburg, VA; Virginia Beach, VA; Roanoke, VA; Richmond, VA; North Chesterfield, VA; Newport News, VA; Leesburg, VA…

National Provider Directory

National Provider Directory

Locations

343 Archer Ave
Charlottesville, VA 22911
Phone (434) 255-0996

1853 Old Donation Pkwy
Virginia Beach, VA 23454
Phone (757) 412-1180

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 118

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 118

NPI Registry JSON

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

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578355200000",
    "number": "1740820828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 SPRING FOREST RD STE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276162816",
            "telephone_number": "919-424-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3365 OGDEN RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240181151",
            "telephone_number": "540-682-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "919-424-5080",
        "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 Roanoke, VA

Sources for this page

Verify at the official NPI Registry.