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General NPI Number Information
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NPI Number | 1427720994
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Entity Type | Organization
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Legal Business Name | LOGAN PHYSICIAN PRACTICE LLC
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 118 S MAIN ST
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City | ELKTON
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State | KY
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Zip | 42220-8863
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Country | US
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Telephone | 270-265-5023
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Fax | 270-265-5026
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Provider Business Mailing Address
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Address Line | 680 S 4TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-2407
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Country | US
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Telephone | 502-596-7300
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT AND CORP SECRETARY
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Name | KATHY J TEAGUE
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Credential |
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Telephone | 629-253-5121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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