Organization
LOGAN MEMORIAL HOSPITAL LLC
Active
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
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000342028
BCBS
—
Enumeration date
04/12/2007
Last updated
06/24/2025
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