1447949995 NPI number — MR. LOGAN ROBERT BASIL MCCALL MB,BCH,BAO

Table of content: MR. LOGAN ROBERT BASIL MCCALL MB,BCH,BAO (NPI 1447949995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447949995 NPI number — MR. LOGAN ROBERT BASIL MCCALL MB,BCH,BAO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCALL
Provider First Name:
LOGAN
Provider Middle Name:
ROBERT BASIL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MB,BCH,BAO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447949995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FAMILY MEDICINE CENTER
Provider Second Line Business Mailing Address:
40 MEDICAL PARK, SUITE 401
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-243-3330
Provider Business Mailing Address Fax Number:
304-243-3891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FAMILY MEDICINE CENTER
Provider Second Line Business Practice Location Address:
40 MEDICAL PARK, SUITE 401
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-243-3330
Provider Business Practice Location Address Fax Number:
304-243-3891
Provider Enumeration Date:
05/02/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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