Provider Demographics
NPI:1801460308
Name:LOGAN AUTHORIZATION
Entity type:Organization
Organization Name:LOGAN AUTHORIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VANITY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-287-3601
Mailing Address - Street 1:3510 S RHODES AVE APT 1605
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-1368
Mailing Address - Country:US
Mailing Address - Phone:312-287-3601
Mailing Address - Fax:
Practice Address - Street 1:3510 S RHODES AVE APT 1605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-1368
Practice Address - Country:US
Practice Address - Phone:312-287-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty