Healthcare Provider Details

I. General information

NPI: 1497742415
Provider Name (Legal Business Name): LOGAN HEALTH - SHELBY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 09/02/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 PARK AVE
SHELBY MT
59474-1663
US

IV. Provider business mailing address

PO BOX 915
SHELBY MT
59474-0915
US

V. Phone/Fax

Practice location:
  • Phone: 406-434-3200
  • Fax:
Mailing address:
  • Phone: 406-434-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number9688
License Number StateMT

VIII. Authorized Official

Name: VICKI NEWMILLER
Title or Position: PRESIDENT
Credential:
Phone: 406-434-3201