Provider Demographics
NPI:1255539730
Name:PRITCHARD, LOGAN A (DO)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:A
Last Name:PRITCHARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-0968
Mailing Address - Country:US
Mailing Address - Phone:402-462-8456
Mailing Address - Fax:402-463-9698
Practice Address - Street 1:1021 W 14TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3046
Practice Address - Country:US
Practice Address - Phone:402-463-2423
Practice Address - Fax:402-463-9698
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00886251OtherRAILROAD MEDICARE
NE42126OtherBCBS NE
NE45126OtherBLUE CROSS BLUE SHIELD
0311840001Medicare NSC