Healthcare Provider Details

I. General information

NPI: 1336746940
Provider Name (Legal Business Name): LOGAN CITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 E 200 N
LOGAN UT
84321-4034
US

IV. Provider business mailing address

290 N 100 W
LOGAN UT
84321-3902
US

V. Phone/Fax

Practice location:
  • Phone: 435-716-9500
  • Fax:
Mailing address:
  • Phone: 435-716-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
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. RICHARD PICKERING ANDERSON
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 435-716-9810