Provider Demographics
NPI:1962492694
Name:LOGAN HEALTH - CONRAD
Entity type:Organization
Organization Name:LOGAN HEALTH - CONRAD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-434-3201
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-0758
Mailing Address - Country:US
Mailing Address - Phone:406-271-5566
Mailing Address - Fax:406-271-5569
Practice Address - Street 1:805 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-1721
Practice Address - Country:US
Practice Address - Phone:406-271-5566
Practice Address - Fax:406-271-5569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT100030972Medicaid
MT000031170OtherBCBS
MT000031170OtherBCBS