NPIMap

Organization Active NPI

Legacy Medical Clinic With Mental Health, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Temple Hills, MD
National Provider Identifier
1912518952
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
LEGACY MEDICAL CLINIC WITH MENTAL HEALTH, LLC
Practice address
4700 Stamp Rd Ste K
Temple Hills, MD 20748-6717
Phone
(301) 880-4900
Fax
(301) 477-4673
NPI assigned
Aug 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Authorized official

Name
Mr. Chuks E Nwaulu, DNP, PMHNP-BC
Title
Owner of the Entity
Phone
(301) 880-4900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

4700 Stamp Rd Ste K
Temple Hills, MD 20748-6717

Mailing address

9509 Manor Oaks VW
Upper Marlboro, MD 20772-3192
Phone (301) 880-4900

National Provider Directory

National Provider Directory
Tax ID family
Legacy Medical Clinic With Mental Health LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4700 Stamp Rd
Ste K
Temple Hills, MD 20748
Phone (301) 880-4900

NPI Registry JSON

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1912518952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9509 MANOR OAKS VW",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723192",
            "telephone_number": "301-880-4900",
            "fax_number": "301-477-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 STAMP RD STE K",
            "city": "TEMPLE HILLS",
            "state": "MD",
            "postal_code": "207486717",
            "telephone_number": "301-880-4900",
            "fax_number": "301-477-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MEDICAL CLINIC WITH MENTAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "NWAULU",
        "authorized_official_first_name": "CHUKS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER OF THE ENTITY",
        "authorized_official_telephone_number": "301-880-4900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DNP, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple Hills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.