Legend Healthcare Jacksonville, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5478 Issued in TX

Legal business name

LEGEND HEALTHCARE JACKSONVILLE, LLC

Practice address

810 Belaire St
Jacksonville, TX 75766-9045

Phone

(903) 589-5300

Fax

(903) 589-5335

NPI assigned

Oct 5, 2006

Organization subpart

No

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

Authorized official

Name

Martin Tomerlin

Title

President

Phone

(210) 564-0100

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deanna Ellen Bishop, FNP-BC

  • Family Nurse Practitioner
  • Nacogdoches, TX
  • NPI 1972982866
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238544000000",
    "number": "1962599738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 SANDAU RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164131",
            "telephone_number": "210-564-0100",
            "fax_number": "210-564-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 BELAIRE ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757669045",
            "telephone_number": "903-589-5300",
            "fax_number": "903-589-5335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGEND HEALTHCARE JACKSONVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2009-04-01",
        "status": "A",
        "authorized_official_last_name": "TOMERLIN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-564-0100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "5478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001014058",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica King, CCC/SLP
• Nikolaos Kombos, PHD
• Bruce Richard Lamond, DDS
• Deborah Garganera Ledesma, FNP-C
• Lauren Lee, PHARM D
• Liberty County Hospital District No. 1
• Linda Cummings
• Amanda Nicole Long, D.O.
• Virginia S Lotito, MS, CCC-SLP
• James Ray Low Jr, MD

• Skilled Nursing Facility in Jacksonville, TX
• Providers in Jacksonville, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2009; 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.