Provider Demographics
NPI:1346394798
Name:LOGAN HEALTH - WHITEFISH
Entity Type:Organization
Organization Name:LOGAN HEALTH - WHITEFISH
Other - Org Name:LOGAN HEALTH PHARMACY COLUMBIA FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MATULIONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-863-3530
Mailing Address - Street 1:2100 9TH ST W
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-4416
Mailing Address - Country:US
Mailing Address - Phone:406-892-9997
Mailing Address - Fax:406-892-2376
Practice Address - Street 1:2100 9TH ST W
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-4416
Practice Address - Country:US
Practice Address - Phone:406-892-9997
Practice Address - Fax:406-892-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT440003336C0003X, 3336C0003X
3336C0003X
MT12588282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0543915Medicaid
2169955OtherPK
2052494OtherPK
MT4768030001Medicare UPIN
2763971OtherOTHER ID NUMBER
MT0213384Medicaid
MT5606627OtherDME