MEDICARE: LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY

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
1	282NC0060X	Critical Access Hospital	2267	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CD8588	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1043213382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGAN HOSPITAL AND MEDICAL CENTER AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 1017
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-1017
Country	:	US
Telephone Number	:	405-282-6700
Fax Number	:	405-282-6790

Provider Business Practice Location Address
First Line	:	200 S ACADEMY RD
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-8727
Country	:	US
Telephone Number	:	405-282-6700
Fax Number	:	405-282-6790

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	STEVE ROWLEY
Credential	:
Telephone Number	:	405-282-6700

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/13/2012

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