MEDICARE: LOGAN ORTHOPAEDICS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	224198	OTHER	KY	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972569630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGAN ORTHOPAEDICS

Provider Business Mailing Address
First Line	:	1623 NASHVILLE ST
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-8889
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 NASHVILLE ST SUITE 103
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-8889
Country	:	US
Telephone Number	:	270-726-6384
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MASOUD HAMIDIAN
Credential	:
Telephone Number	:	270-726-6384

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	08/22/2020

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Practice Location Address:

1623 NASHVILLE ST , SUITE 201
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1831181593 — DR. STEVE G SALYERS MD
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1871559583 — LOGAN ORTHOPAEDICS
Practice Location Address:

1623 NASHVILLE ST
RUSSELLVILLE, KY
42276-8889

Practice Phone: 270-726-6384
Practice Fax:

1245263631 — LOGAN MEMORIAL HOSPITAL
Practice Location Address:

1623 NASHVILLE ST , SUITE 105
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1003918731 — DR. ADAM WESLEY ELLIS M.D
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1033216270 — ADAM ELLIS, MD, PLLC
Practice Location Address:

1623 NASHVILLE ST , SUITE 106
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Directions to “LOGAN ORTHOPAEDICS ” Practice Location

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