Provider Demographics
NPI:1073061859
Name:LOGAN CALAHAN
Entity Type:Organization
Organization Name:LOGAN CALAHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-208-0079
Mailing Address - Street 1:5028 CUMBERLAND CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2011
Mailing Address - Country:US
Mailing Address - Phone:971-599-5355
Mailing Address - Fax:
Practice Address - Street 1:5028 CUMBERLAND CT SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-2011
Practice Address - Country:US
Practice Address - Phone:971-599-5355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18761302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization