Provider Demographics
NPI:1992893416
Name:LOGAN MEMORIAL HOSPITAL LLC
Entity type:Organization
Organization Name:LOGAN MEMORIAL HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VICE PRESIDENT, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8913
Practice Address - Street 1:1625 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8853
Practice Address - Country:US
Practice Address - Phone:270-726-4011
Practice Address - Fax:270-726-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY73282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01000132Medicaid
KY5000013OtherUNITED HEALTHCARE
IN100038770AMedicaid
KY000000055027OtherBLUE CROSS
KY1096575OtherPASSPORT HEALTH
TN0180066Medicaid
KY360698OtherBLACK LUNG
KYKYMCO11BOtherWORKERS COMP
KY000000342028OtherBLUE CROSS LABORATORY
KY166291400OtherACS
IN100038770AMedicaid