Organization
LOGAN PRIMARY CARE SERVICE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TARA GAYEL DEATON (ADMINISTRATOR)
(618) 993-3300
Entity
Organization
Contact information
Practice address
405 RUSHING DR, HERRIN, IL 62948
(618) 993-3300
(618) 997-6626
Mailing address
405 RUSHING DR, HERRIN, IL 62948
(618) 993-3300
(618) 997-6626
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143870
—
IL
Enumeration date
08/24/2006
Last updated
04/15/2008
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