Logan Surgical Suites LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

LOGAN SURGICAL SUITES LLC

Doing business as

Advanced Surgery Center of Northern Utah

Practice address

55 East Golf Course Road
Logan, UT 84321-0001

Phone

(435) 760-3734

NPI assigned

Oct 1, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Marielle Whitlock, R.N.

Title

Administrator

Phone

(435) 760-3734

Specialties & licenses 1

Addresses

Other names 1

• Advanced Surgery Center of Northern Utah Doing business as

Listed as

Advanced Surgery Center of Northern Utah LBN Logan Surgical Suites LLCCCN 46C0001063

Medicare certification status

ActiveFrom the Provider of Services file

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1104301613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 EAST GOLF COURSE ROAD",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843210001",
            "telephone_number": "435-787-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 EAST GOLF COURSE ROAD",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843210001",
            "telephone_number": "435-760-3734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN SURGICAL SUITES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-01",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "WHITLOCK",
        "authorized_official_first_name": "MARIELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "435-760-3734",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Surgery Center of Northern Utah",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Surgery Center of Northern Utah",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Logan Radiology Group LLC
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• Logan Sleep Diagnostics, Inc
• Logan Surgery Center, LLC (Intermountain Health Surgery Center - Logan)
• Logan Urgent Care (5 Minute Clinic)
• Logan Urology Clinic
• Logansmiles LLC
• Ashley Lomu
• Grace Angela Longaker

• Ambulatory Surgical Clinic/Center in Logan, UT
• Providers in Logan, UT by specialty
• Ambulatory Surgical Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.