John Marcus Legan, MD
Individual provider Active NPI Diagnostic Radiology Physician · Dyersburg, TN
NPI 1790779130 · NPPES record last updated Jan 11, 2010
Key facts
- NPI
- 1790779130
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- MD25386 (TN)
- Practice address
- 400 E Tickle St
Dyersburg, TN 38024-3120 - Phone
- (731) 285-2346
- NPI assigned
- Aug 31, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in TN, AR, MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101228000050 | TN | Practitioner - Diagnostic Radiology | 1759367923 | Reassigns benefits to 2 organizations |
| I20220806000110 | AR | Practitioner - Diagnostic Radiology | 1759367923 | Reassigns benefits to 1 organization |
| I20220809001560 | MS | Practitioner - Diagnostic Radiology | 1759367923 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD25386 | TN | MD | Diagnostic Radiology Physician |
| 25386 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Independent Radiology Associates PLC | Diagnostic Radiology | Current |
Accepting new patients |
| Bolivar General Hospital, Inc. | Past | Accepting new patients | |
| USA Radiology of Pennsylvania, LLC | Past | Accepting new patients | |
| Bolivar General Hospital, Inc. | Past | Accepting new patients |
Locations
2000 Holiday Ln
Fulton, KY 42041
Phone (270) 472-2522
400 E Tickle St
Dyersburg, TN 38024
Phone (731) 285-2410
305 W Court St
Dyersburg, TN 38024
Phone (731) 285-2346
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | MD25386 | TN | Yes |
Addresses
Primary practice location
400 E Tickle St
Dyersburg, TN 38024-3120
Mailing address
PO Box 1296
Dyersburg, TN 38025-1296
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3083641 | Medicaid | TN |
Other providers in Dyersburg, TN
- Anna Jiyoung Lee-Mulay
- Amanda Lee
- Joan H Lee
- Amanda Marie Leedy
- Melissa Carol Lefave
- Regina Faye Leggett
- Merrill L Lemon
- Brandi Lemons
- Garine Lepejian
- Jake Lewis
All providers in Dyersburg, TN · Diagnostic Radiology Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.