Healthcare Provider Details

I. General information

NPI: 1770542144
Provider Name (Legal Business Name): LOGAN VIEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DOWELL AVE
BELLEFONTAINE OH
43311-2305
US

IV. Provider business mailing address

110 DOWELL AVE
BELLEFONTAINE OH
43311-2305
US

V. Phone/Fax

Practice location:
  • Phone: 937-593-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHMEL.11005
License Number StateOH

VIII. Authorized Official

Name: TAMARA GUMP
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 937-593-0245