Organization
LOGAN PEDIATRICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OKPANI M NNACHI M.D. (MEDICAL DIRECTOR)
(304) 831-0073
Entity
Organization
Contact information
Practice address
60 HOSPITAL DR, LOGAN, WV 25601-3452
(304) 831-0073
(304) 831-0076
Mailing address
PO BOX 117, LOGAN, WV 25601-0117
(304) 831-0073
(304) 831-0076
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21990
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810012095
—
WV
Enumeration date
05/24/2007
Last updated
07/02/2008
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