Healthcare Provider Details
I. General information
NPI: 1235401126
Provider Name (Legal Business Name): LOGAN URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
981 S MAIN ST SUITE #180
LOGAN UT
84321-6053
US
IV. Provider business mailing address
981 S MAIN ST SUITE #180
LOGAN UT
84321-6053
US
V. Phone/Fax
- Phone: 435-753-2848
- Fax: 435-753-0155
- Phone: 435-753-2848
- Fax: 435-753-0155
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QU0200X |
| Taxonomy | Urgent Care Clinic/Center |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name: MR.
CHRISTOPHER
JAMES
MORGAN
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: F.N.P.
Phone: 435-753-2848