Provider Demographics
NPI:1790803765
Name:LOGAN HEALTH - CONRAD
Entity Type:Organization
Organization Name:LOGAN HEALTH - CONRAD
Other - Org Name:LOGAN HEALTH EMS - CONRAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-434-3207
Mailing Address - Street 1:805 SUNSET BLVD
Mailing Address - Street 2:PO 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 1:15 5TH AVE SW
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-2521
Practice Address - Country:US
Practice Address - Phone:406-271-3211
Practice Address - Fax:406-271-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000060712OtherBCBS
MT0441285Medicaid
MT0441285Medicaid