Provider Demographics
NPI:1336115849
Name:LOGAN HEALTH - WHITEFISH
Entity Type:Organization
Organization Name:LOGAN HEALTH - WHITEFISH
Other - Org Name:EUREKA HEALTHCARE PRIMARY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-863-3500
Mailing Address - Street 1:304 OSLOSKI RD
Mailing Address - Street 2:PO BOX 810
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-9217
Mailing Address - Country:US
Mailing Address - Phone:406-297-3145
Mailing Address - Fax:
Practice Address - Street 1:304 OSLOSKI RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917
Practice Address - Country:US
Practice Address - Phone:406-297-3145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
MT12588261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000081879OtherMEDICARE PART B
MT000081879OtherMEDICARE PART B