Provider Demographics
NPI:1043213382
Name:LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY
Entity Type:Organization
Organization Name:LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY
Other - Org Name:LOGAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-282-6700
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-1017
Mailing Address - Country:US
Mailing Address - Phone:405-282-6700
Mailing Address - Fax:405-282-6790
Practice Address - Street 1:200 S ACADEMY RD
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-8727
Practice Address - Country:US
Practice Address - Phone:405-282-6700
Practice Address - Fax:405-282-6790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2267282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD8588OtherRAILROAD MEDICARE
OK100700110AMedicaid
OK100700110GMedicaid
CD8588OtherRAILROAD MEDICARE
OK100700110GMedicaid