Provider Demographics
NPI:1376541136
Name:LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY
Entity Type:Organization
Organization Name:LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY
Other - Org Name:LMC - SOUTH DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:405-260-4191
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:405-282-6301
Mailing Address - Fax:
Practice Address - Street 1:2919 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6806
Practice Address - Country:US
Practice Address - Phone:405-282-6301
Practice Address - Fax:405-282-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2267261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700110JMedicaid
OK100700110EMedicaid
CD8588OtherRAILROAD MEDICARE
37-3993Medicare ID - Type Unspecified
L37012101Medicare PIN