MEDICARE: LOGAN CIRCLE HEALTH SUPPLIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1326569617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGAN CIRCLE HEALTH SUPPLIES

Provider Business Mailing Address
First Line	:	331 GEORGE KOSTAS DR STE 302
Second Line	:
City	:	LOGAN
State	:	WV
Zip	:	25601-3493
Country	:	US
Telephone Number	:	202-798-5919
Fax Number	:

Provider Business Practice Location Address
First Line	:	331 GEORGE KOSTAS DR STE 302
Second Line	:
City	:	LOGAN
State	:	WV
Zip	:	25601-3493
Country	:	US
Telephone Number	:	202-798-5919
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MUHAMMAD WAQAR
Credential	:
Telephone Number	:	202-798-5919

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	07/21/2022

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Directions to “LOGAN CIRCLE HEALTH SUPPLIES ” Practice Location

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