Provider Demographics
NPI:1396409173
Name:LOGAN PEDIATRICS, INC
Entity Type:Organization
Organization Name:LOGAN PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OKPANI
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:NNACHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-831-0073
Mailing Address - Street 1:300 PROSPERITY LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601
Mailing Address - Country:US
Mailing Address - Phone:304-831-0073
Mailing Address - Fax:304-831-0076
Practice Address - Street 1:300 PROSPERITY LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601
Practice Address - Country:US
Practice Address - Phone:304-831-0073
Practice Address - Fax:304-831-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health