| Logan Family Medicine, Llc | |
|
8845 Rhea County Hwy Dayton TN 37321-5926 | |
| (423) 775-4261 | |
| (423) 775-6988 |
| Full Name | Logan Family Medicine, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8845 Rhea County Hwy, Dayton, Tennessee |
| Authorized Official Name and Position | Lee Daniel Logan (MANAGING MEMBER) |
| Authorized Official Contact | 4237754261 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Family Medicine, Llc 8845 Rhea County Hwy Dayton TN 37321-5926 Ph: (423) 775-4261 | Logan Family Medicine, Llc 8845 Rhea County Hwy Dayton TN 37321-5926 Ph: (423) 775-4261 |
| NPI Number | 1619113867 |
|---|---|
| Provider Enumeration Date | 12/17/2008 |
| Last Update Date | 06/25/2019 |
| Medicare PECOS PAC ID | 2769546266 |
|---|---|
| Medicare Enrollment ID | O20090128000281 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619113867 | NPI | - | NPPES |
| DO 1846 | Other | TN | TN LICENSE |
| 4718093 | Other | TN | CIGNA |
| 1511366 | Medicaid | TN | |
| 4157006 | Other | TN | BCBS |
| PTAN P00416016 | Other | TN | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | DO 1846 (Tennessee) | Primary |
| Provider Name | Lee D Logan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336188085 PECOS PAC ID: 2961414420 Enrollment ID: I20070802000618 |
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