Organization
LOGAN PHYSICIAN PRACTICE LLC
Active
Organization
LOGAN PHYSICIAN PRACTICE LLC
Active
Other names
Logan Primary Care - Russellville
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (VP, CORPORATE SECRETARY)
(629) 253-5121
Entity
Organization
Contact information
Practice address
975 HOPKINSVILLE RD, RUSSELLVILLE, KY 42276-9774
(270) 726-2738
(270) 726-9508
Mailing address
113 SEABOARD LN STE 201B, FRANKLIN, TN 37067-8284
(629) 253-5121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/25/2018
Last updated
04/13/2023
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