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	275N00000X	Medicare Defined Swing Bed Hospital Unit	2267	OK

General Provider Information

NPI Number	:	1487693057
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	:

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	:

Authorized Official
Title or Position	:	CEO
Name	:	STEVE ROWLEY
Credential	:
Telephone Number	:	405-260-4191

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	11/15/2007

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