| Logan Wildcat Health Center | |
|
1 Wildcat Way Logan WV 25601-3474 | |
| (304) 688-9949 | |
| (304) 688-9953 |
| Full Name | Logan Wildcat Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1 Wildcat Way, Logan, West Virginia |
| Authorized Official Name and Position | Lisa Leach (CEO) |
| Authorized Official Contact | 3048245806 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Wildcat Health Center 7400 Lynn Ave Hamlin WV 25523-1138 Ph: (304) 824-5806 | Logan Wildcat Health Center 1 Wildcat Way Logan WV 25601-3474 Ph: (304) 688-9949 |
| NPI Number | 1366723975 |
|---|---|
| Provider Enumeration Date | 09/09/2011 |
| Last Update Date | 03/08/2023 |
| Medicare PECOS PAC ID | 6204821879 |
|---|---|
| Medicare Enrollment ID | O20111031000323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366723975 | NPI | - | NPPES |
| 3810022652 | Medicaid | WV | |
| 51D2055311 | Other | WV | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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