Provider Demographics
NPI:1366748220
Name:LEGACY MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:LEGACY MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-255-3361
Mailing Address - Street 1:3813 NW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-999-8984
Practice Address - Street 1:3813 NW 51ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2045
Practice Address - Country:US
Practice Address - Phone:405-255-3361
Practice Address - Fax:888-999-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSV07343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)