LEGACY HEALTH CLINIC LLC NPI 1942670005

NPI Information

NPI: 1942670005
Provider Name: LEGACY HEALTH CLINIC, LLC
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Organization

Specialization: Adult Health

CLIA Number: 02D2103660

Address:
3524 TONGASS AVE
KETCHIKAN, AK
ZIP 99901
Phone: (907) 225-6355
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LEGACY HEALTH CLINIC, LLC is an adult health nurse practitioner in Ketchikan, AK. LEGACY HEALTH CLINIC, LLC NPI is 1942670005. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3524 TONGASS AVE
KETCHIKAN, AK
ZIP 99901-635
Phone: (907) 225-6355

The provider's authorized official is Helen R Klein .
The authorized official title is Owner and has the following contact phone number (907) 225-6355.

The CLIA number assigned to this NPI record is 02D2103660 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/1/2015 and was last updated on 10/1/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	551	ALASKA	No
2	363LA2200X	Nurse Practitioner	Adult Health	1106	ALASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	1580081	MEDICAID	ALASKA
2	K164537	MEDICARE PIN	ALASKA
3	1022301	MEDICAID	ALASKA
4	K162622	MEDICARE PIN	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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