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Organization
LOGAN PRIMARY CARE SERVICE CORP.
Active
Organization
LOGAN PRIMARY CARE SERVICE CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA G DEATON (ADMINISTRATOR)
(618) 993-3300
Entity
Organization
Contact information
Practice address
405 RUSHING DRIVE, HERRIN, IL 62948
(618) 993-3300
(618) 997-6626
Mailing address
405 RUSHING DRIVE, HERRIN, IL 62948
(618) 993-3300
(618) 997-6626
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
036081556
IL
Other
Enumeration date
08/19/2006
Last updated
03/16/2012
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