Healthcare Provider Details

I. General information

NPI: 1992893416
Provider Name (Legal Business Name): LOGAN MEMORIAL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 NASHVILLE ST
RUSSELLVILLE KY
42276-8853
US

IV. Provider business mailing address

680 S 4TH ST # KH-3
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 270-726-4011
  • Fax: 270-726-7465
Mailing address:
  • Phone: 502-596-6063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number73
License Number StateKY

VIII. Authorized Official

Name: JOHNETTA TRAYLOR
Title or Position: AO
Credential:
Phone: 502-596-6063