MEDICARE: MR. LOGAN MEEKS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1043548712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOGAN MEEKS

Provider Business Mailing Address
First Line	:	1551 FRONTER DRIVE
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901
Country	:	US
Telephone Number	:	307-389-6579
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 FRONTIER DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-7403
Country	:	US
Telephone Number	:	307-389-6579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2009
Last Update Date	:	11/18/2009

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