Basic Information
| Provider Information | |||||||||
| NPI: | 1396710851 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOGAN HEALTH - WHITEFISH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LOGAN HEALTH REHABILITATION EUREKA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 HOSPITAL WAY | ||||||||
| Address2: | |||||||||
| City: | WHITEFISH | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599372958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068633500 | ||||||||
| FaxNumber: | 4068627805 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 HOSPITAL WAY | ||||||||
| Address2: | |||||||||
| City: | WHITEFISH | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068633724 | ||||||||
| FaxNumber: | 4068633732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PFS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4068633724 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | N | Hospitals | General Acute Care Hospital | Critical Access | 282NC0060X | 10361 | MT | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 00452 | 01 | MT | NORTH VALLEY HOSPITAL-CAH | OTHER |