Provider Demographics
NPI:1497867089
Name:LOGAN PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:LOGAN PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-726-1266
Mailing Address - Street 1:975 HOPKINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9774
Mailing Address - Country:US
Mailing Address - Phone:270-726-1266
Mailing Address - Fax:270-726-1961
Practice Address - Street 1:975 HOPKINSVILLE RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-9774
Practice Address - Country:US
Practice Address - Phone:270-726-1266
Practice Address - Fax:270-726-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39621208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty