| NPI | 1013408053 |
|---|---|
| Doing Business As | LOGAN PRIMARY CARE - RUSSELLVILLE |
| Entity Type | Organization |
| Authorized Contact | KATHY TEAGUE VP, Corporate Secretary 629-253-5121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208000000X Pediatrics | |
| 261QR1300X Clinic/Center, Rural Health | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2023-04-13 |