Logan Urology Clinic

LBN: Logan Urology Clinic
Logan Urology Clinic is an health care organization with primary practice located at 550 E 1400 N Ste J, Logan UT 84341-2406. The organization recently has only one registered license in Managed Care Organizations / Exclusive Provider Organization, which is considered as the primary health care specialty. Logan Urology Clinic can be contacted via phone (435) 753-1171, or through Larsen, Ryan Harold via phone (435) 753-1171.

Contact Information

Primary practice address
550 E 1400 N Ste J Logan UT 84341-2406
Phone: (435) 753-1171
Fax: (435) 792-4464
Website:
Map and Directions
Authorized official contact:
Name: Larsen, Ryan Harold Doctor of Medicine (MD)
Phone: (435) 753-1171

Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Exclusive Provider Organization 302F00000X 175141-1205 Utah

Profile Details

NPI number 1326274507
LBN Legal business name Logan Urology Clinic
DBA Doing business as
Authorized official Larsen, Ryan Harold Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 Yes
Enumeration date Jun 2nd, 2009
Last updated Jun 2nd, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326274507 NPPES
Idaho MEDICAID 340017516
Idaho MEDICAID 08582

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