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General NPI Number Information
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NPI Number | 1275202061
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Entity Type | Organization
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Legal Business Name | LOGAN CRIST PA & COMPANY
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 1497 SOLITAIRE ST
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City | COLORADO SPGS
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State | CO
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Zip | 80905-4255
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Country | US
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Telephone | 440-371-3063
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Fax |
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Provider Business Mailing Address
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Address Line | 1497 SOLITAIRE ST
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City | COLORADO SPGS
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State | CO
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Zip | 80905-4255
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Country | US
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Telephone | 440-371-3063
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRIST LOGAN
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Credential |
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Telephone | 440-371-3063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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