# LOGAN PRIMARY CARE SERVICE CORP.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396850616
- **Authorized official:** TARA G DEATON (ADMINISTRATOR)
- **Authorized official phone:** (618) 993-3300

## Contact information

- **Practice address:** 405 RUSHING DRIVE, HERRIN, IL 62948
- **Practice address phone:** (618) 993-3300
- **Practice address fax:** (618) 997-6626
- **Mailing address:** 405 RUSHING DRIVE, HERRIN, IL 62948
- **Mailing address phone:** (618) 993-3300
- **Mailing address fax:** (618) 997-6626

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 036081556 | IL | Yes |

## Other

- **Enumeration date:** 08/19/2006
- **Last updated:** 03/16/2012