Healthcare Provider Details

I. General information

NPI: 1063082980
Provider Name (Legal Business Name): LOGAN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 N 500 E
LOGAN UT
84341-2400
US

IV. Provider business mailing address

1350 N 500 E
LOGAN UT
84341-2400
US

V. Phone/Fax

Practice location:
  • Phone: 435-363-9265
  • Fax:
Mailing address:
  • Phone: 435-363-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDON MCBRIDE
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-890-0263