Logan Family Practice, LLC
Organization Active NPI Primary Care Clinic/Center · Logan, NM
NPI 1902044597 · NPPES record last updated Feb 23, 2014
Key facts
- NPI
- 1902044597
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- R14626 (NM)
- Legal business name
- LOGAN FAMILY PRACTICE, LLC
- Practice address
- 600 Gallegos
Logan, NM 88426-7602 - Phone
- (575) 487-9000
- Fax
- (575) 487-9002
- NPI assigned
- Feb 4, 2009
- Organization subpart
- No
Authorized official
- Name
- Mrs. Lajuana Dell Willis, CFNP
- Title
- Member
- Phone
- (575) 487-9000
National Provider Directory
Locations
400 Sunset
#A
Logan, NM 88426
Phone (505) 487-9000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | R14626 | NM | Yes |
| Family Nurse Practitioner |
363LF0000X | R14626 | NM |
Addresses
Primary practice location
600 Gallegos
Logan, NM 88426-7602
Mailing address
600 Gallegos
Logan, NM 88426-7602
Phone (575) 487-9000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28184564 | Medicaid | NM |
Other providers in Logan, NM
- Abal, LCC
- Autumn Blessings Assistd Living, LLC
- Joyce Elaine Feerer
- Jenna Lindsay Gorman
- Sharon Darlene Oliver
- Village of Logan
- La Juana Dell Willis
All providers in Logan, NM · Primary Care Clinic/Center in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.