Active NPI
Logan S Clark, PA-C
- Physician Assistant
- Magna, UT
National Provider Identifier
1154593275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5262016-1206
- Practice address
- 8211 W 3500 S
Magna, UT 84044-1851 - Phone
- (801) 250-9638
- Fax
- (801) 250-3204
- NPI assigned
- Mar 28, 2008
- Last updated
- Mar 28, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5262016-1206 | UT | Primary |
Addresses
Primary practice location
8211 W 3500 S
Magna, UT 84044-1851
Mailing address
3336 Pioneer Pkwy
Suite 201
West Valley, UT 84120-2000
Phone (801) 250-9638
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5262016-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Exodus Healthcare Network PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206662400000",
"number": "1154593275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3336 PIONEER PKWY",
"address_2": "SUITE 201",
"city": "WEST VALLEY",
"state": "UT",
"postal_code": "841202000",
"telephone_number": "801-250-9638",
"fax_number": "801-417-0063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8211 W 3500 S",
"city": "MAGNA",
"state": "UT",
"postal_code": "840441851",
"telephone_number": "801-250-9638",
"fax_number": "801-250-3204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LOGAN",
"middle_name": "S",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-28",
"last_updated": "2008-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "5262016-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Magna, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.