NPIMap

Organization Active NPI

Timothy W. Logan, D.M.D., P.S.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Louisville, KY
National Provider Identifier
1427349687
Registry record updated Apr 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
5015 Issued in KY
Legal business name
TIMOTHY W. LOGAN, D.M.D., P.S.C.
Practice address
9800 Shelbyville Rd
Suite 202
Louisville, KY 40223-5440
Phone
(502) 429-0526
Fax
(502) 429-0532
NPI assigned
Apr 22, 2011
Last updated
Apr 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2011

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

Authorized official

Name
Dr. Timothy Wilson Logan, D.M.D.NPI 1548227655
Title
Owner
Phone
(502) 429-0526

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 5015 KY Primary

Addresses

Primary practice location

9800 Shelbyville Rd
Suite 202
Louisville, KY 40223-5440

Mailing address

9800 Shelbyville Road
Suite 202
Louisville, KY 40223-5440
Phone (502) 429-0526

Other identifiers 2

IdentifierTypeStateIssuer
000000049874OtherBLUE CROSS/BLUE SHIEL
1548227655OtherNPI TYPE 1

National Provider Directory

National Provider Directory

Locations

9800 Shelbyville Rd
Ste 202
Louisville, KY 40223
Phone (502) 429-0526

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1303430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303430400000",
    "number": "1427349687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9800 SHELBYVILLE ROAD",
            "address_2": "SUITE 202",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402235440",
            "telephone_number": "502-429-0526",
            "fax_number": "502-429-0532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9800 SHELBYVILLE RD",
            "address_2": "SUITE 202",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402235440",
            "telephone_number": "502-429-0526",
            "fax_number": "502-429-0532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY W. LOGAN, D.M.D., P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-22",
        "last_updated": "2011-04-22",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-429-0526",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "5015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIEL",
            "identifier": "000000049874",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1548227655",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.