Basic Information
| Provider Information | |||||||||
| NPI: | 1538140942 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOGAN EMERGENCY PHYSICIANS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2078 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257202078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003778721 | ||||||||
| FaxNumber: | 3045232241 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | LOGANSPORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469471528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5747537541 | ||||||||
| FaxNumber: | 5747531515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KRSTEVSKI | ||||||||
| AuthorizedOfficialFirstName: | LAZO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8003778721 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.