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Organization

LOGAN PRIMARY CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TARA G DEATON (ADMINISTRATOR)
(618) 997-3400
Entity
Organization

Contact information

Practice address
405 RUSHING DR, HERRIN, IL 62948-3730
(618) 993-3300
(618) 932-3797
Mailing address
502 E SAINT LOUIS ST, WEST FRANKFORT, IL 62896-1346
(618) 993-3300
(618) 932-3797

Taxonomy

Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
IL

Other

Enumeration date
10/11/2007
Last updated
10/11/2007
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