Logan Physician Practice LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

LOGAN PHYSICIAN PRACTICE LLC

Practice address

128 Sugar Maple Dr
Auburn, KY 42206-5352

Phone

(270) 344-5157

NPI assigned

Dec 14, 2012

Organization subpart

Yes

Parent organization

LOGAN PHYSICIAN PRACTICE LLCAs reported in NPPES

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

Authorized official

Name

Kathy J Teague

Title

VP and Corporate Secretary

Phone

(629) 253-5121

Specialties & licenses 1

Addresses

Other names 1

• AUBURN COMMUNITY HEALTH CLINIC Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

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

• Logan Physician Practice LLC

  • Internal Medicine Physician
  • Russellville, KY
  • NPI 1013408053

  O20040219000212

  Same enrollment
• Logan Physician Practice LLC

  • Family Medicine Physician
  • Russellville, KY
  • NPI 1649203043

  O20040219000212

  Same enrollment
• Logan Physician Practice, LLC

  • Nurse Practitioner
  • Auburn, KY
  • NPI 1265740765

  O20040219000212

  Same enrollment

Part of

Logan Physician Practice

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Bowling Green-Warren County Community Hospital Corporation

  • Rural Health Clinic/Center
  • Auburn, KY
  • NPI 1134965015

  Sold to, 2024-07-01

  CMS change of ownership

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melissa D Corbin

  • Nurse Practitioner
  • Russellville, KY
  • NPI 1922678143
  NPD
• Stephanie Geraci

  • Nurse Practitioner
  • Hopkinsville, KY
  • NPI 1770954745
  NPD
• Kimberly Ann Owens, APRN

  • Family Nurse Practitioner
  • Munfordville, KY
  • NPI 1568640993
  NPD
• Kelly S Tate, MD

  • Family Medicine Physician
  • Elkton, KY
  • NPI 1700839040
  NPD

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

{
    "created_epoch": "1355443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701129600000",
    "number": "1891031191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 SUGAR MAPLE DR",
            "city": "AUBURN",
            "state": "KY",
            "postal_code": "422065352",
            "telephone_number": "270-344-5157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 SUGAR MAPLE DR",
            "city": "AUBURN",
            "state": "KY",
            "postal_code": "422065352",
            "telephone_number": "270-344-5157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN PHYSICIAN PRACTICE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOGAN PHYSICIAN PRACTICE LLC",
        "enumeration_date": "2012-12-14",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VP AND CORPORATE SECRETARY",
        "authorized_official_telephone_number": "629-253-5121"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AUBURN COMMUNITY HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AUBURN COMMUNITY HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexander Lee Gaddie, PTA
• Heartland Family Pharmacy LLC
• Austin Brooke Higgins, COTA
• Sara Adkins Horton
• Tara M Jackson
• Logan Physician Practice, LLC
• Krista Nash-Posey
• Cindy Pawley
• Stefanie Layne Shrull, DI
• Jessica Smith, OTR/L

• Rural Health Clinic/Center in Auburn, KY
• Providers in Auburn, KY by specialty
• Rural Health Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.