Provider Demographics
NPI:1811164429
Name:FORT LOGAN HOSPITAL
Entity type:Organization
Organization Name:FORT LOGAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SNAPP
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:859-239-2424
Mailing Address - Street 1:110 METKER TRAIL
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484
Mailing Address - Country:US
Mailing Address - Phone:606-365-2187
Mailing Address - Fax:
Practice Address - Street 1:110 METKER TRAIL
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484
Practice Address - Country:US
Practice Address - Phone:606-365-2187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000209723OtherFACETS