Logan Physician Practice LLC
Organization Active NPI Internal Medicine Physician · Russellville, KY
NPI 1013408053 · NPPES record last updated Apr 13, 2023
Key facts
- NPI
- 1013408053
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- LOGAN PHYSICIAN PRACTICE LLC
- Practice address
- 975 Hopkinsville Rd
Russellville, KY 42276-9774 - Phone
- (270) 726-2738
- Fax
- (270) 726-9508
- NPI assigned
- May 25, 2018
- Organization subpart
- No
Authorized official
- Name
- Kathy Teague
- Title
- VP, Corporate Secretary
- Phone
- (629) 253-5121
Other NPIs on the same Medicare enrollment 3
Corporate family (same tax ID) 3
Practitioners 14
-
Erinn Lynn Basista, DNP, APRN, FNP-C
-
Cynthia Jo Bond, APRN
-
Janie Elizabeth Davis, ARNP
-
Adam Wesley Ellis, M.D
-
Kristen Erica Hunkin, PHD, PMHNP-BC, FNP-C
-
Blair R Mendoza, APRN
-
Kimberly Ann Owens, APRN
-
Steve G Salyers, MD
-
Abhilasha M. Singh, M.D.
-
James Marvin Staples, ARNP
-
Stacia Ashley Staples, ARNP
-
Kelly S Tate, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040219000212 | KY | Part B Supplier - Clinic/Group Practice | 4880596592 |
Receives reassigned benefits from 14 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Auburn, KY; Elkton, KY; Russellville, KY |
National Provider Directory
- Tax ID family
- Logan Physician Practice
Locations
128 Sugar Maple Dr
Auburn, KY 42206
Phone (270) 344-5157
1625 Nashville St
#106
Russellville, KY 42276
Phone (270) 726-1785
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| Pediatrics Physician |
208000000X | |||
| Rural Health Clinic/Center | 261QR1300X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
975 Hopkinsville Rd
Russellville, KY 42276-9774
Mailing address
113 Seaboard LN Ste 201B
Franklin, TN 37067-8284
Phone (629) 253-5121
Other names
- Logan Primary Care - Russellville
Other providers in Russellville, KY
- Logan Memorial Hospital LLC
- Logan Memorial Hospital LLC
- Logan Orthopaedics
- Logan Orthopaedics
- Logan Pediatrics, PLLC
- Logan Physician Practice LLC
- Martha E Loomis
- Lymphedema Therapy of Southern Ky LLC
- Laura Madison
- Joe V Massa
All providers in Russellville, KY · Internal Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.