Healthcare Provider Details

I. General information

NPI: 1487693057
Provider Name (Legal Business Name): LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ACADEMY RD
GUTHRIE OK
73044-8727
US

IV. Provider business mailing address

PO BOX 1017
GUTHRIE OK
73044-1017
US

V. Phone/Fax

Practice location:
  • Phone: 405-282-6700
  • Fax:
Mailing address:
  • Phone: 405-282-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number2267
License Number StateOK

VIII. Authorized Official

Name: STEVE ROWLEY
Title or Position: CEO
Credential:
Phone: 405-260-4191