Provider Demographics
NPI:1639399058
Name:VILLAGE OF LOGAN
Entity type:Organization
Organization Name:VILLAGE OF LOGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-403-6870
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:NM
Mailing Address - Zip Code:88426-0007
Mailing Address - Country:US
Mailing Address - Phone:505-487-2234
Mailing Address - Fax:505-487-2400
Practice Address - Street 1:108A US HWY 54
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:NM
Practice Address - Zip Code:88426
Practice Address - Country:US
Practice Address - Phone:505-487-2234
Practice Address - Fax:505-487-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM12549341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR170OtherBCBS
NMR2577Medicaid
NM39910OtherPRES SALUD, MEDICAID
NM8182424OtherUNITED HEALTHCARE
NMC253004OtherUNITED AMERICA
NM590005180OtherRAILROAD MEDICARE
NM=========OtherPRESBYTERIAN HEALTH PLAN
NMR2577Medicaid
NM39910OtherPRES SALUD, MEDICAID
NM=========OtherTRIWEST
NMR170OtherBCBS