Provider Demographics
NPI:1689005357
Name:COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY
Entity Type:Organization
Organization Name:COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-887-1013
Mailing Address - Street 1:4879 US ROUTE 68 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357
Mailing Address - Country:US
Mailing Address - Phone:937-599-1411
Mailing Address - Fax:937-599-4128
Practice Address - Street 1:4879 US HIGHWAY 68 S
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357-9525
Practice Address - Country:US
Practice Address - Phone:937-599-1411
Practice Address - Fax:937-599-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096025Medicaid
OH361037Medicare Oscar/Certification