LEGACY DIAGNOSTIC LABS LLC
NPI 1205788338
Clinical Medical Laboratory in Princeville, NC

Active since February 11, 2026CLIA 34D2343764 · Waiver
417 TOLBERT PL, PRINCEVILLE, NC 27886(252) 710-7830 Get Directions Write a Review

NPPES record last updated: February 11, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Legacy Diagnostic Labs Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LEGACY DIAGNOSTIC LABS LLC (NPI 1205788338) is a healthcare organization registered as a clinical medical laboratory in Princeville, North Carolina and active in the NPI registry since February 2026. The organization holds a CLIA Waiver certificate valid through May 11, 2028 and lists Jesicka Andrews, Owner, as its authorized official.

NPPES Registry Identity

NPI1205788338
Entity TypeOrganization
Primary Taxonomy291U00000X
Legal Business NameLEGACY DIAGNOSTIC LABS LLC
Location Address417 TOLBERT PLPrinceville, NC 27886-9615
Mailing Address417 Tolbert PlPrinceville, NC 27886-9615 · (252) 710-7830
Organization SubpartNo
Authorized OfficialJesicka AndrewsOwner · (252) 366-3250
Enumeration DateFebruary 11, 2026
NPPES CertifiedFebruary 11, 2026
NPI 1205788338 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinical Medical LaboratoryLaboratories
Taxonomy Code291U00000X
Definition
(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.
417 TOLBERT PL, Princeville, NC 27886

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2343764

Legacy Diagnostic Labs LLC · Princeville, NC
Active · expires May 11, 2028
CLIA Number34D2343764
Laboratory TypeMobile Laboratory
Certificate Effective DateMay 12, 2026
Certificate Expiration DateMay 11, 2028
Laboratory DirectorJesicka Andrews
Laboratory Phone(252) 710-7830
Laboratory LocationLegacy Diagnostic Labs LLC417 Tolbert Pl, Princeville, NC 27886
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Legacy Diagnostic Labs LLC's NPI number?

The NPI number for Legacy Diagnostic Labs LLC is 1205788338. It was assigned to this organization in the NPPES registry on February 11, 2026.

Where is Legacy Diagnostic Labs LLC located?

Legacy Diagnostic Labs LLC is located at 417 Tolbert Pl, Princeville, NC 27886. The listed phone number is (252) 710-7830.

What is Legacy Diagnostic Labs LLC's specialty?

The primary specialty registered for this NPI is Clinical Medical Laboratory with taxonomy code 291U00000X.

Does Legacy Diagnostic Labs LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2343764) is associated with this NPI, valid through May 11, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Legacy Diagnostic Labs LLC was last updated on February 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.