Organization
LOGAN PEDIATRICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OKPANI MARTIN NNACHI MD (MEDICAL DIRECTOR)
(304) 831-0073
Entity
Organization
Contact information
Practice address
300 PROSPERITY LANE, SUITE 100, LOGAN, WV 25601
(304) 831-0073
(304) 831-0076
Mailing address
300 PROSPERITY LANE, SUITE 100, LOGAN, WV 25601
(304) 831-0073
(304) 831-0076
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/27/2021
Last updated
10/27/2021
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