| Southern West Virgina Health System-logan | |
|
122 Nick Savas Drive Logan WV 25601-3468 | |
| (304) 752-8081 | |
| (304) 752-8083 |
| Full Name | Southern West Virgina Health System-logan |
|---|---|
| Speciality | Clinic/Center |
| Location | 122 Nick Savas Drive, 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 |
|---|---|
| Southern West Virgina Health System-logan 7400 Lynn Avenue Hamlin WV 25523-1138 Ph: (304) 824-5806 | Southern West Virgina Health System-logan 122 Nick Savas Drive Logan WV 25601-3468 Ph: (304) 752-8081 |
| NPI Number | 1023331220 |
|---|---|
| Provider Enumeration Date | 03/03/2010 |
| Last Update Date | 03/08/2023 |
| Medicare PECOS PAC ID | 6204821879 |
|---|---|
| Medicare Enrollment ID | O20101023000316 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023331220 | NPI | - | NPPES |
| 3810020368 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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