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Organization
LOGAN MEMORIAL HOSPITAL LLC
Active
Organization
LOGAN MEMORIAL HOSPITAL LLC
Active
Other names
Logan Memorial Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (AO)
(502) 596-6063
Entity
Organization
Contact information
Practice address
1625 NASHVILLE ST, RUSSELLVILLE, KY 42276-8853
(270) 726-4011
(270) 726-7465
Mailing address
680 S 4TH ST # KH-3, LOUISVILLE, KY 40202-2407
(502) 596-6063
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
73
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000055027
BLUE CROSS
KY
01
—
000000342028
BLUE CROSS LABORATORY
KY
05
—
01000132
—
KY
05
—
0180066
—
TN
05
—
100038770A
—
IN
01
—
1096575
PASSPORT HEALTH
KY
01
—
166291400
ACS
KY
01
—
360698
BLACK LUNG
KY
01
—
5000013
UNITED HEALTHCARE
KY
01
—
KYMCO11B
WORKERS COMP
KY
Enumeration date
10/10/2006
Last updated
06/24/2025
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