=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750332565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOGAN GENERAL HOSPITAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2006
-----------------------------------------------------
Last Update Date | 06/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 HOSPITAL DR
-----------------------------------------------------
City | LOGAN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25601-3452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-831-1101
-----------------------------------------------------
Fax | 304-831-1871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 S 4TH ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-596-6063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AO
-----------------------------------------------------
Name | JOHNETTA TRAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-596-6063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NR1301X
-----------------------------------------------------
Taxonomy Name | Rural Acute Care Hospital
-----------------------------------------------------
License Number | 73
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------