Organization
LOGAN ORTHOPAEDICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASOUD HAMIDIAN (OWNER)
(270) 726-6384
Entity
Organization
Contact information
Practice address
1623 NASHVILLE ST SUITE 103, RUSSELLVILLE, KY 42276-8889
(270) 726-6384
Mailing address
1623 NASHVILLE ST, RUSSELLVILLE, KY 42276-8889
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
224198
ANTHEM PROVIDER NUMBER
KY
05
—
90006081
—
KY
Enumeration date
04/21/2006
Last updated
08/22/2020
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