# LOGAN PRIMARY CARE

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

## Provider details

- **NPI number:** 1992951123
- **Authorized official:** MICAH OAKLEY PA-C (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (618) 993-3300

## Contact information

- **Practice address:** 405 RUSHING DR, HERRIN, IL 62948-3730
- **Practice address phone:** (618) 993-3300
- **Practice address fax:** (618) 993-0262
- **Mailing address:** 405 RUSHING DR, HERRIN, IL 62948-3730
- **Mailing address phone:** (618) 993-3300
- **Mailing address fax:** (618) 993-0262

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AM0700X | Medical Physician Assistant | 085-003043 | IL | Yes |

## Other

- **Enumeration date:** 08/07/2008
- **Last updated:** 08/07/2008