Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Logan Slack

Individual provider Physician Assistant · NPI 1982328480

Logan Slack is a Physician Assistant in Bemidji, Minnesota. Qualified in 2023, 3 years ago. Practices with Sanford Health of Northern Minnesota, a 349-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
3
Licensed in
MN
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

1300 Anne St NW
Bemidji, MN 56601-5103
Phone: (218) 751-9746
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 14888 (MN)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1982328480
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 28, 2022
Last updated in NPPESMay 20, 2024
Certification dateMay 20, 2024
Mailing addressPo Box 5074, Sioux Falls, SD 57117-5074

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Sanford Health Of Northern Minnesota — 349 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Bemidji