Provider Demographics
NPI:1619113867
Name:LOGAN FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:LOGAN FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-775-4261
Mailing Address - Street 1:8845 RHEA COUNTY HWY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5926
Mailing Address - Country:US
Mailing Address - Phone:423-775-4261
Mailing Address - Fax:423-775-6988
Practice Address - Street 1:8845 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5926
Practice Address - Country:US
Practice Address - Phone:423-775-4261
Practice Address - Fax:423-775-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO 1846261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDO 1846OtherTN LICENSE
TN4718093OtherCIGNA
TN1511366Medicaid
TN4157006OtherBCBS
TNPTAN P00416016OtherMEDICARE RAILROAD
TN4157006OtherBCBS