# LOGAN SURGICAL SUITES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Surgery Center of Northern Utah
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104301613
- **Authorized official:** MRS. MARIELLE WHITLOCK R.N. (ADMINISTRATOR)
- **Authorized official phone:** (435) 760-3734

## Contact information

- **Practice address:** 55 EAST GOLF COURSE ROAD, LOGAN, UT 84321-0001
- **Practice address phone:** (435) 760-3734
- **Mailing address:** 55 EAST GOLF COURSE ROAD, LOGAN, UT 84321-0001
- **Mailing address phone:** (435) 787-7190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/01/2018
- **Last updated:** 09/23/2021