| Logan Family Medical Center Llc | |
|
2210 Timber Trl Bellefontaine OH 43311-9039 | |
| (937) 593-3151 | |
| Not Available |
| Full Name | Logan Family Medical Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2210 Timber Trl, Bellefontaine, Ohio |
| Authorized Official Name and Position | Mabbu G Shivaprasad (PHYSICIAN) |
| Authorized Official Contact | 9375933151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Family Medical Center Llc 2210 Timber Trl Bellefontaine OH 43311-9039 Ph: (937) 593-3151 | Logan Family Medical Center Llc 2210 Timber Trl Bellefontaine OH 43311-9039 Ph: (937) 593-3151 |
| NPI Number | 1285824979 |
|---|---|
| Provider Enumeration Date | 07/28/2007 |
| Last Update Date | 07/28/2007 |
| Medicare PECOS PAC ID | 7517865272 |
|---|---|
| Medicare Enrollment ID | O20031219000616 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285824979 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 35072257 (Ohio) | Primary |
| Provider Name | Mabbu G Shiva Prasad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083795850 PECOS PAC ID: 2961300637 Enrollment ID: I20031222000143 |
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