| South Logan Family Practice | |
|
895 S Logan St Denver CO 80209-4127 | |
| (303) 733-3764 | |
| (303) 733-0868 |
| Full Name | South Logan Family Practice |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 895 S Logan St, Denver, Colorado |
| Authorized Official Name and Position | Nathaniel J Moore (OWNER) |
| Authorized Official Contact | 3037333764 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Logan Family Practice 895 S Logan St Denver CO 80209-4127 Ph: (303) 733-3764 | South Logan Family Practice 895 S Logan St Denver CO 80209-4127 Ph: (303) 733-3764 |
| NPI Number | 1932507613 |
|---|---|
| Provider Enumeration Date | 12/12/2014 |
| Last Update Date | 11/06/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932507613 | NPI | - | NPPES |
| 01355437 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 35543 (Colorado) | Primary |
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