| Logan Internal Medicine Group | |
|
77 Hospital Drive Suite 101 Logan WV 25601-3451 | |
| (304) 831-0450 | |
| (304) 831-0452 |
| Full Name | Logan Internal Medicine Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 77 Hospital Drive, Logan, West Virginia |
| Authorized Official Name and Position | Fernando Luis Gonzalez-ramos (CEO) |
| Authorized Official Contact | 3048310450 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Internal Medicine Group Po Box 1617 Logan WV 25601-1617 Ph: (304) 831-0450 | Logan Internal Medicine Group 77 Hospital Drive Suite 101 Logan WV 25601-3451 Ph: (304) 831-0450 |
| NPI Number | 1730117896 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 02/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730117896 | NPI | - | NPPES |
| 3810011047 | Medicaid | WV | |
| 001860338 | Other | BCBS OF MICHIGAN | |
| 001860338 | Other | MOUNTAIN STATE BCBS | |
| DF2728 | Other | WV | RR MEDICARE |
| 438170 | Other | ADVANTRA FREEDOM | |
| 438170 | Other | COVENTRY HEALTH | |
| 611399500 | Other | BLACK LUNG |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
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