Organization · Type 2 NPI
Red Tyde
Medical Physician Assistant · Logan, UT
NPI number
1679156004
Active
Practice location
196 S 100 W
Logan, UT 84321-5233
Fax (833) 359-1642
Mailing address
280 S Main St
Bountiful, UT 84010-6236
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | None listed |
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | None listed |
| Primary Care Clinic/Center | 261QP2300X | None listed |
| Medical Physician Assistant Primary | 363AM0700X | None listed |
Medical Physician Assistant: Definition to come...
4 other providers at this address
- Cache Valley Medical and WellnessClinic/Center Logan, UT NPI 1790087559
- Salt Hill Counseling, PLLCMental Health Counselor Logan, UT NPI 1407702947
- Deborah Michelle Austin, LCSWClinical Social Worker Logan, UT NPI 1699231142
- Tiffany Marie Redmond, PA-C, LPCPhysician Assistant Logan, UT NPI 1457486805
About NPI 1679156004
Red Tyde's National Provider Identifier is 1679156004, issued on May 3, 2021. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Logan, UT. The record was last updated on Oct 15, 2026.