Basic Information
| Provider Information | |||||||||
| NPI: | 1285948539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOGAN HEALTH - WHITEFISH | ||||||||
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| OtherOrganizationName: | NORTH VALLEY FAMILY MEDICINE A DIVISION OF NORTH VALLEY HOSPITAL | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 HOSPITAL WAY | ||||||||
| Address2: | |||||||||
| City: | WHITEFISH | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599377849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068633500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1675 TALBOT RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599124416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068923208 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2010 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PFS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4068633724 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CHFP, CRCR | ||||||||
| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | 12588 | MT | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | M000009945 | 01 | MT | MEDICARE PART B | OTHER |