West Logan Primary Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

WEST LOGAN PRIMARY CARE LLC

Practice address

947 Old Logan Rd
Logan, WV 25601-3341

Phone

(304) 831-0085

NPI assigned

Aug 22, 2023

Last updated

Dec 9, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Eva StanleyNPI 1700568748

Title

Owner

Phone

(304) 946-8286

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 2

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.

• Eva Leah Stanley, FNP

  • Family Nurse Practitioner
  • Logan, WV
  • NPI 1700568748
  Medicare reassignment NPD Authorized official
• Karunasree Kanuri, M.D.,

  • Family Medicine Physician
  • West Logan, WV
  • NPI 1174612907
  NPD (past)

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

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702080000000",
    "number": "1730963604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 HURRICANE BRANCH RD",
            "city": "CHAPMANVILLE",
            "state": "WV",
            "postal_code": "255085241",
            "telephone_number": "304-946-8286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "947 OLD LOGAN RD",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013341",
            "telephone_number": "304-831-0085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST LOGAN PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-12-09",
        "certification_date": "2023-12-09",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "EVA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-946-8286"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loretta Watkins
• William Ray Watkins Jr., RN, MSN, NP
• Darcy Lynn Watts
• Cynthia Waugh
• Linda Wells
• West Virginia Heart & Vascular Institute Logan Inc
• White Eye Care Center Inc.
• Danielle White, OTR
• George White
• Julie White, BA

• Primary Care Clinic/Center in Logan, WV
• Providers in Logan, WV by specialty
• Primary Care Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2023; 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.