Provider Demographics
NPI:1669461703
Name:LOGAN HEALTH - CONRAD
Entity Type:Organization
Organization Name:LOGAN HEALTH - CONRAD
Other - Org Name:LOGAN HEALTH RURAL HEALTH CLINIC - CONRAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-271-3211
Mailing Address - Street 1:805 SUNSET BLVD
Mailing Address - Street 2:P O BOX 758
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-1717
Mailing Address - Country:US
Mailing Address - Phone:406-271-3211
Mailing Address - Fax:406-271-3917
Practice Address - Street 1:809 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-1799
Practice Address - Country:US
Practice Address - Phone:406-271-3231
Practice Address - Fax:406-271-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000066442OtherBCBS
MT0720392Medicaid
MT0720392Medicaid
MT000066442OtherBCBS