Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1219 N 400 E, Logan, Utah |
Authorized Official Name and Position | Corey B Johnson (PRESIDENT) |
Authorized Official Contact | 4357532842 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1219 N 400 E Logan UT 84341-2321 Ph: (435) 753-2842 | 1219 N 400 E Logan UT 84341-2321 Ph: (435) 753-2842 |
NPI Number | 1114115763 |
---|---|
Provider Enumeration Date | 10/09/2007 |
Last Update Date | 10/09/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114115763 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 1848241205 (Utah) | 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 | |