Provider Demographics
NPI:1902506488
Name:LOGIC PRIME INDUSTRIES
Entity Type:Organization
Organization Name:LOGIC PRIME INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDDIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:314-496-8998
Mailing Address - Street 1:3390 GREENWAY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1540
Mailing Address - Country:US
Mailing Address - Phone:314-496-8998
Mailing Address - Fax:
Practice Address - Street 1:3390 GREENWAY CHASE DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1540
Practice Address - Country:US
Practice Address - Phone:314-496-8998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)