Full Name | |
---|---|
Speciality | Clinic/center |
Location | 1350 N 500 E, Logan, Utah |
Authorized Official Name and Position | Mark Briesacher (SVP-CHIEF PHYS EXEC/PRES IMGROUP) |
Authorized Official Contact | 8014423495 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 27128 Salt Lake City UT 84127-0128 Ph: (435) 657-4400 | 1350 N 500 E Logan UT 84341-2400 Ph: (435) 752-0422 |
NPI Number | 1154826618 |
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Provider Enumeration Date | 03/27/2018 |
Last Update Date | 04/30/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154826618 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Ihc Health Services Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 550 E 1400 N Ste Xy, Logan, UT 84341 Phone: 435-757-1315 | |
Bridge Utah Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1015 E 100 N, Logan, UT 84321 Phone: 888-221-0423 Fax: 888-221-9816 | |