| Logan Family Practice, Llc | |
|
600 Gallegos Logan NM 88426-7602 | |
| (575) 487-9000 | |
| (575) 487-9002 |
| Full Name | Logan Family Practice, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 600 Gallegos, Logan, New Mexico |
| Authorized Official Name and Position | Lajuana Dell Willis (MEMBER) |
| Authorized Official Contact | 5754879000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Family Practice, Llc 600 Gallegos Logan NM 88426-7602 Ph: (575) 487-9000 | Logan Family Practice, Llc 600 Gallegos Logan NM 88426-7602 Ph: (575) 487-9000 |
| NPI Number | 1902044597 |
|---|---|
| Provider Enumeration Date | 02/04/2009 |
| Last Update Date | 02/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902044597 | NPI | - | NPPES |
| 28184564 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R14626 (New Mexico) | Primary |
| 363LF0000X | Nurse Practitioner - Family | R14626 (New Mexico) | Secondary |