Village of Logan
Organization Active NPI Ambulance · Logan, NM
NPI 1639399058 · NPPES record last updated Feb 7, 2025
Key facts
- NPI
- 1639399058
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- License
- 12549 (NM)
- Legal business name
- VILLAGE OF LOGAN
- Practice address
- 108A US Hwy 54
Logan, NM 88426 - Phone
- (505) 487-2234
- Fax
- (505) 487-2400
- NPI assigned
- Apr 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Justin Leblanc
- Title
- EMS Director
- Phone
- (575) 403-6870
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100809001112 | NM | Part B Supplier - Ambulance Service Supplier | 5890828081 | Practice locations: Logan, NM |
National Provider Directory
Locations
111 S Whittier Rd
Wichita, KS 67207
Phone (316) 689-4203
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 12549 | NM | Yes |
Addresses
Primary practice location
108A US Hwy 54
Logan, NM 88426
Mailing address
PO Box 7
Logan, NM 88426-0007
Phone (505) 487-2234
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R170 | Other | NM | BCBS |
| R2577 | Medicaid | NM | |
| 39910 | Other | NM | PRES SALUD, MEDICAID |
| 8182424 | Other | NM | UNITED HEALTHCARE |
| C253004 | Other | NM | UNITED AMERICA |
| 590005180 | Other | NM | RAILROAD MEDICARE |
Other names
- Logan Ambulance Service
Other providers in Logan, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2025. 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.