Provider Demographics
NPI:1609874759
Name:LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY
Entity Type:Organization
Organization Name:LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY
Other - Org Name:LOGAN MEDICAL CENTER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MESSELT
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:405-282-9406
Mailing Address - Fax:405-282-9404
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:405-282-9406
Practice Address - Fax:405-282-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7251251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
37-7258Medicare ID - Type Unspecified