Provider Demographics
NPI:1700169497
Name:MERCY HOSPITAL LOGAN COUNTY, INC
Entity Type:Organization
Organization Name:MERCY HOSPITAL LOGAN COUNTY, INC
Other - Org Name:MERCY HOSPITAL LOGAN COUNTY SWING BEDS
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUSE DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-8439
Mailing Address - Street 1:200 S ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-8727
Mailing Address - Country:US
Mailing Address - Phone:405-282-6700
Mailing Address - Fax:
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:405-282-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-20
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-Z317OtherMEDICARE PROVIDER #