Organization
LOGAN FAMILY MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MABBU G SHIVAPRASAD MD (PHYSICIAN)
(937) 593-3151
Entity
Organization
Contact information
Practice address
2210 TIMBER TRL, BELLEFONTAINE, OH 43311-9039
(937) 593-3151
Mailing address
2210 TIMBER TRL, BELLEFONTAINE, OH 43311-9039
(937) 593-3151
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
35072257
OH
Other
Enumeration date
07/28/2007
Last updated
07/28/2007
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