Legacy Medical Lab Services, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

45D2010680 Issued in TX

Legal business name

LEGACY MEDICAL LAB SERVICES, LLC

Practice address

688 Alliance Pkwy
Suite #200
Hewitt, TX 76643-3585

Phone

(254) 420-4522

Fax

(254) 420-1144

NPI assigned

Aug 18, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Lisa Kay Rahimi

Title

Vice President

Phone

(254) 732-3658

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1902111610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "city": "HEWITT",
            "state": "TX",
            "postal_code": "766430008",
            "telephone_number": "254-420-4522",
            "fax_number": "254-420-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 ALLIANCE PKWY",
            "address_2": "SUITE #200",
            "city": "HEWITT",
            "state": "TX",
            "postal_code": "766433585",
            "telephone_number": "254-420-4522",
            "fax_number": "254-420-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MEDICAL LAB SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-18",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "RAHIMI",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "254-732-3658",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D2010680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID NUMBER",
            "identifier": "45D2010680",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "217525901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLA NUMBER",
            "identifier": "22110",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "217525902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Camille Plasek Koehler, PTA
• Amy Kyle, PT
• Teresa Ann Laseter, LCSW
• Terry Lassiter, D.D.S.
• Loretta Bryce Lee, M.S., CCC-SLP
• Jessica Louise Licea
• Yeseul Lim, OD
• Ryan Litke, LPC
• Jelisa Lott
• E. Wade Loudamy, PT

• Clinical Medical Laboratory in Hewitt, TX
• Providers in Hewitt, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; 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.