LEGACY HEALTH PA (NPI# 1780147108) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780147108 |
| Entity Type | Organization |
| Organization Name | LEGACY HEALTH PA |
| Practice Address |
3049 Senna Dr Matthews NC 28105-6727 |
| Practice Telephone | 9803395155 |
| Practice Fax Number | 9802168522 |
| Mailing Telephone | 9803395155 |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2019-04-11 |
| Authorized Official Name | DR. BRIAN JERBY (LEAD PHYSICIAN) |
| Authorized Official Telephone | 9803395155 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Legacy Health | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | LEGACY HEALTH PARTNERS, LLC | 1919 Nw Lovejoy Street, Portland, OR 97209 |
| Street Address |
3049 SENNA DR |
| City | MATTHEWS |
| State | NC |
| Zip Code | 28105-6727 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447861968 | Carolina Colon & Rectal Specialists Pa | Colon & Rectal Surgery | 3049 Senna Dr, Matthews, NC 28105-6727 | 2020-08-10 |
| 1215561097 | Susan Heather Jerby | Nurse Practitioner | 3049 Senna Dr, Matthews, NC 28105-6727 | 2020-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750917407 | Lauren Deasy Blackshaw | Counselor | 1163 Sam Newell Rd, Matthews, NC 28105 | 2020-03-13 |
| 1912549643 | Monarch | Community/Behavioral Health | 10545 Paces Avenue 634, Matthews, NC 28105 | 2019-10-15 |
| 1326515768 | Holly Harvey Heddleson | Nurse Practitioner | 1450 Matthews Township Pkwy Ste 280, Matthews, NC 28105 | 2018-10-24 |
| 1396241030 | Erickson Health Medical Group of North Carolina, PC | Internal Medicine | 2030 Windsor Run Lane, Matthews, NC 28105 | 2018-04-02 |
| 1811406994 | Lice Clinics of America of The Carolinas | Technician, Other | 3042 Suite C Senna Dr, Matthews, NC 28105 | 2017-09-21 |
| 1376065003 | Carillon Assisted Living of Mint Hill, LLC | Custodial Care Facility | 5601 Margaret Wallace Road, Matthews, NC 28105 | 2017-07-14 |
| 1568906055 | London Young | Physical Therapy Assistant | 11100- 11189 Berkley Square Ln, Charlotte, NC 28105 | 2016-12-19 |
| 1003363128 | New Beginnings Community Counseling Center | Community/Behavioral Health | 5232 Maragaret Wallace Road, Matthews, NC 28105 | 2016-09-07 |
| 1275993149 | Kristi Dougan | Nurse Practitioner | 434 N Trade St Ste 104, Matthews, NC 28105 | 2016-03-04 |
| 1205219896 | Kalyani Vellanki Starr | Dentist | 1819 Matthews Township Pkwy Ste 200, Matthews, NC 28105 | 2015-07-01 |
| Find all providers in zip 28105 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447448345 | Carolinas Physicians Network Inc. | Clinic/Center | 1811 Matthews Township Pkwy, Matthews, NC 28105-4659 | 2007-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407460603 | Fonshaunna Alston | Clinic/Center | 107 Grandimere Ct, Durham, NC 27703-9613 | 2020-09-04 |
| 1255949731 | New Life Peer Support and Coaching LLC | Clinic/Center | 3450 Toringdon Way, Suite 200, Charlotte, NC 28277 | 2020-07-21 |
| 1790306819 | Aeroflow Connect LLC | Clinic/Center | 3165 Sweeten Creek Rd, Asheville, NC 28803-2115 | 2020-04-29 |
| 1811518244 | Haven Total Wellness, Pllc | Clinic/Center | 149 Woodlawn St Suite C, West End, NC 27376 | 2020-04-27 |
| 1073156931 | Coastal Carolina Primary Care, Pllc | Clinic/Center | 15441 Us Highway 17 N Ste 501, Hampstead, NC 28443-0016 | 2019-10-23 |
| 1396303178 | Chiroduo | Clinic/Center | 6816 Ray Rd, Raleigh, NC 27613-3237 | 2019-06-05 |
| 1114496502 | Acupuncture Balanced Health | Clinic/Center | 112 Perkins Dr Ste 200, Chapel Hill, NC 27514-1786 | 2018-11-15 |
| 1972071884 | Our Health Lab Inc | Clinic/Center | 1411 Asheville Hwy, Hendersonville, NC 28791-2301 | 2018-11-08 |
| 1679041552 | Serenity Rehabilitation Services | Clinic/Center | 2216 W Meadowview Rd Ste 201, Greensboro, NC 27407-3401 | 2018-11-08 |
| 1083125892 | Johnson Therapy Services | Clinic/Center | 10216 Perimeter Pkwy # 9, Charlotte, NC 28216-2461 | 2017-10-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.