Provider Demographics
NPI:1891031191
Name:LOGAN PHYSICIAN PRACTICE LLC
Entity Type:Organization
Organization Name:LOGAN PHYSICIAN PRACTICE LLC
Other - Org Name:AUBURN COMMUNITY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AND CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:128 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42206-5352
Mailing Address - Country:US
Mailing Address - Phone:270-344-5157
Mailing Address - Fax:
Practice Address - Street 1:128 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-5352
Practice Address - Country:US
Practice Address - Phone:270-344-5157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOGAN PHYSICIAN PRACTICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-14
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health