| Logan Family Health | |
|
104 Main St Logan WV 25601-3607 | |
| (304) 752-4950 | |
| (304) 752-9452 |
| Full Name | Logan Family Health |
|---|---|
| Speciality | Family Medicine |
| Location | 104 Main St, Logan, West Virginia |
| Authorized Official Name and Position | Wendy White (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3046887027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Family Health 104 Main St Logan WV 25601-3607 Ph: (304) 752-9450 | Logan Family Health 104 Main St Logan WV 25601-3607 Ph: (304) 752-4950 |
| NPI Number | 1841073673 |
|---|---|
| Provider Enumeration Date | 08/15/2023 |
| Last Update Date | 08/22/2023 |
| Medicare PECOS PAC ID | 2567814890 |
|---|---|
| Medicare Enrollment ID | O20240123000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841073673 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Martin L Codispoti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265717250 PECOS PAC ID: 3274791439 Enrollment ID: I20120220001166 |
| Provider Name | Amber Brooke Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508565235 PECOS PAC ID: 5193184422 Enrollment ID: I20230705003151 |
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