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NPI Code Detail

MEDICARE: LOGAN RADIOLOGY GROUP LLC

MEDICARE: LOGAN RADIOLOGY GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianUT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043212988
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOGAN RADIOLOGY GROUP LLC
Provider Business Mailing Address
First Line : PO BOX 1108
Second Line :
City : BOUNTIFUL
State : UT
Zip : 84011-1108
Country : US
Telephone Number : 801-296-2113
Fax Number : 801-296-1715
Provider Business Practice Location Address
First Line : 1400 N 500 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-2455
Country : US
Telephone Number : 281-980-1430
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : C RICHARD HOPKINS
Credential : MD
Telephone Number : 801-296-2113
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/21/2022

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Directions to “LOGAN RADIOLOGY GROUP LLC ” Practice Location

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