Healthcare Provider Details

I. General information

NPI: 1689470775
Provider Name (Legal Business Name): LOGAN HECKART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88TH MDG/SGHE 4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433
US

IV. Provider business mailing address

88TH MDG/SGHE 4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-6877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: