LOGAN SURGICAL SUITES LLC NPI 1104301613

NPI Information

  • NPI: 1104301613
  • Provider Name: LOGAN SURGICAL SUITES LLC
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • Doing Business As: ADVANCED SURGERY CENTER OF NORTHERN UTAH
  • CLIA Number: 46D2156197
  • Address: 55 EAST GOLF COURSE ROAD
    LOGAN, UT
    ZIP 84321
  • Phone: (435) 760-3734

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NPI Details

LOGAN SURGICAL SUITES LLC is an ambulatory surgical clinic center in Logan, UT. LOGAN SURGICAL SUITES LLC NPI is 1104301613. The provider is registered as an organization entity type.
The provider Is Doing Business As Advanced Surgery Center Of Northern Utah.

The provider's business location address is:

55 EAST GOLF COURSE ROAD
LOGAN, UT
ZIP 84321-001
Phone: (435) 760-3734

The provider's authorized official is Marielle Whitlock .
The authorized official title is Administrator and has the following contact phone number (435) 760-3734.

The CLIA number assigned to this NPI record is 46D2156197 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Injection, bupivacaine liposome, 1 mg (HCPCS:C9290)
  • Replacement of knee joint, both sides of knee (HCPCS:27447)
  • Release and/or relocation of hand nerve (HCPCS:64721)
  • Anchoring of biceps tendon (HCPCS:23430)
  • Incision of tendon covering of finger (HCPCS:26055)
  • Repair of shoulder rotator cuff using an endoscope (HCPCS:29827)
  • Removal of bone joints between wrist and fingers (HCPCS:25447)
  • Removal of both knee cartilages using an endoscope (HCPCS:29880)
  • Heat destruction of intraosseous basivertebral nerve in bones of spine in lower back, first two bones (HCPCS:64628)
  • Partial removal of collar bone at shoulder using an endoscope (HCPCS:29824)
  • Repair of chronic torn shoulder rotator cuff (HCPCS:23412)
  • Imaging guidance for procedure, 60 minutes or less (HCPCS:76000)

The enumeration date for this NPI number is 10/1/2018 and was last updated on 9/23/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory SurgicalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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