Provider Demographics
NPI:1851336564
Name:NORTHLAND CHEST CONSULTANTS, INC.
Entity Type:Organization
Organization Name:NORTHLAND CHEST CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-781-8445
Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-781-8445
Mailing Address - Fax:816-781-8413
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 402
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-781-8445
Practice Address - Fax:816-781-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR7E84174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11804014OtherBCBS
MO50328103Medicaid
MO0750000Medicare PIN