Provider Demographics
NPI:1689870941
Name:CABARRUS ROWAN COMMUNITY HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:CABARRUS ROWAN COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:LOGAN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-792-2203
Mailing Address - Street 1:298 LINCOLN ST SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5469
Mailing Address - Country:US
Mailing Address - Phone:704-920-1065
Mailing Address - Fax:704-792-2272
Practice Address - Street 1:298 LINCOLN ST SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5469
Practice Address - Country:US
Practice Address - Phone:704-920-1065
Practice Address - Fax:704-792-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344534CMedicaid
NC344534AMedicaid
NC341915Medicare Oscar/Certification