1366606600 NPI number — LEGEND HEALTH, INC.

Table of content: DR. VASILIKI A. MORAGIANNI M.D. (NPI 1255591277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366606600 NPI number — LEGEND HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGEND HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366606600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 FLIGHTLINE DR STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33811-2801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-644-4747
Provider Business Mailing Address Fax Number:
863-644-9898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3131 FLIGHTLINE DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33811-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-644-4747
Provider Business Practice Location Address Fax Number:
863-644-9898
Provider Enumeration Date:
07/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PUTNAM
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
863-644-4747

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)