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550 E 1400 N Ste Xy Logan UT 84341-2406 | |
(801) 393-5355 | |
(801) 394-4609 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 550 E 1400 N Ste Xy, Logan, Utah |
Authorized Official Name and Position | Sonja Levesque (CFO) |
Authorized Official Contact | 8013341327 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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550 E 1400 N Ste Xy Logan UT 84341-2406 Ph: (801) 393-5355 | 550 E 1400 N Ste Xy Logan UT 84341-2406 Ph: (801) 393-5355 |
NPI Number | 1053780171 |
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Provider Enumeration Date | 09/18/2015 |
Last Update Date | 11/30/2018 |
Identifier | Type | State | Issuer |
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1053780171 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (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 | |