NPIMap

Organization Active NPI

Logan Physician Practice, LLC

Doing business as Auburn Community Family Clinic

  • Nurse Practitioner
  • Auburn, KY
National Provider Identifier
1265740765
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
LOGAN PHYSICIAN PRACTICE, LLC
Doing business as
Auburn Community Family Clinic
Practice address
128 Sugar Maple Drive
Auburn, KY 42206
Phone
(615) 957-0847
NPI assigned
Sep 17, 2010
Last updated
Jul 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kathy J Teague
Title
Vice President and Corp Secretary
Phone
(629) 253-5121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

128 Sugar Maple Drive
Auburn, KY 42206

Mailing address

128 Sugar Maple Drive
Auburn, KY 42206
Phone (615) 957-0847

Other names 1

  • Auburn Community Family Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000212 KY Part B Supplier - Clinic/Group Practice 4880596592 Receives reassigned benefits from 14 practitioners
3 other NPIs on this enrollment
Practice locations: Auburn, KY; Elkton, KY; Russellville, KY

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Logan Physician Practice4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1265740765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 SUGAR MAPLE DRIVE",
            "city": "AUBURN",
            "state": "KY",
            "postal_code": "42206",
            "telephone_number": "615-957-0847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 SUGAR MAPLE DRIVE",
            "city": "AUBURN",
            "state": "KY",
            "postal_code": "42206",
            "telephone_number": "615-957-0847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN PHYSICIAN PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-17",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT AND CORP SECRETARY",
        "authorized_official_telephone_number": "629-253-5121"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Auburn Community Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Auburn, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.