Organization
LOGAN MEMORIAL HOSPITAL LLC
Active
Other names
Logan Memorial Hospital
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
282NR1301X
Rural Acute Care Hospital
Primary
73
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000055027
BLUE CROSS
KY
01
—
000000342028
BLUE CROSS LABORATORY
KY
05
—
01000132
—
KY
05
—
0180066
—
TN
05
—
100038770A
—
IN
01
—
1096575
PASSPORT HEALTH
KY
01
—
166291400
ACS
KY
01
—
360698
BLACK LUNG
KY
01
—
5000013
UNITED HEALTHCARE
KY
01
—
KYMCO11B
WORKERS COMP
KY
Enumeration date
10/10/2006
Last updated
06/24/2025
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