1316945272 NPI number — LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY

Table of content: (NPI 1316945272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316945272 NPI number — LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER FOR INTERNAL MEDICINE AND PEDICATRICS - ACADEMY
Provider Other Organization Name Type Code:
3
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:
1316945272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1017
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUTHRIE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73044-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-282-9449
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 S ACADEMY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUTHRIE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73044-8727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-282-9449
Provider Business Practice Location Address Fax Number:
405-282-9403
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROWLEY
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-260-4191

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  2267 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CJ5177 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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