| West Logan Primary Care Llc | |
|
947 Old Logan Rd Logan WV 25601-3341 | |
| (304) 831-0085 | |
| Not Available |
| Full Name | West Logan Primary Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 947 Old Logan Rd, Logan, West Virginia |
| Authorized Official Name and Position | Eva Stanley (OWNER) |
| Authorized Official Contact | 3049468286 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Logan Primary Care Llc 1776 Hurricane Branch Rd Chapmanville WV 25508-5241 Ph: (304) 946-8286 | West Logan Primary Care Llc 947 Old Logan Rd Logan WV 25601-3341 Ph: (304) 831-0085 |
| NPI Number | 1730963604 |
|---|---|
| Provider Enumeration Date | 08/22/2023 |
| Last Update Date | 12/09/2023 |
| Medicare PECOS PAC ID | 0648627240 |
|---|---|
| Medicare Enrollment ID | O20231103000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730963604 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Eva Leah Stanley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700568748 PECOS PAC ID: 1557718152 Enrollment ID: I20231208003401 |
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