Logan Primary Care Service Corporation in Herrin - Family Medicine
Logan Primary Care Service Corporation - NPI 1821105974
Logan Primary Care Service Corporation is a Family Medicine in Herrin, Illinois. Logan Primary Care Service Corporation practices all healthcare services and medical treatments related to Family Medicine. The NPI Number for Logan Primary Care Service Corporation is 1821105974. The last update date is 2007-11-29.
Logan Primary Care Service Corporation's current location address is 405 Rushing Drive, Herrin, Illinois. You can contact this provider via phone number 6189933300 and fax number 6189976626. The mailing address for Logan Primary Care Service Corporation is 405 Rushing Drive, Herrin, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Logan Primary Care Service Corporation |
|---|---|
| Address | 405 Rushing Drive, Herrin, Illinois |
| Phone Number | 6189933300 |
| Fax Number | 6189976626 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | ADMINISTRA |
|---|---|
| Authorized Official Name | Deaton G Tara |
| Telephone Number | 6189933300 |
NPI Number Detail
| NPI Number | 1821105974 |
|---|---|
| Provider Enumeration Date | 2006-08-24 |
| Last Updated Date | 2007-11-29 |
Provider Mailing Address Detail
| Address | 405 Rushing Drive |
|---|---|
| City | Herrin |
| State | Illinois (IL) |
| Post Code | 62948 |
| Phone Number | 6189933300 |
| Fax Number | 6189976626 |
Provider's Primary Taxonomy Detail
| Speciality | Family Medicine |
|---|---|
| Taxonomy | 207Q00000X |
| Licence No | 36099669 |
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Definition: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine i |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 14D0666068 | CLIA | ||
| 143870 | IL | -- | |
| 14D0436594 | CLIA | ||
| 14D0963522 | CLIA | ||
| 10019630 | IL | BLUE CROSS BLUE SHIELD | |
| 14D1041426 | CLIA |
Post Comment/ Review Below
What is the unique identifier code issued to Logan Primary Care Service Corporation by the Centers for Medicare & Medicaid Services?
The Logan Primary Care Service Corporation has been assigned the NPI (National Provider Identifier) 1821105974. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete address where Logan Primary Care Service Corporation is physically located?
The Logan Primary Care Service Corporation is situated at the following address: 405 Rushing Drive, Herrin, IL 62948.
What is Logan Primary Care Service Corporation's specialized field of practice, and what is the corresponding taxonomy classification code?
The Logan Primary Care Service Corporation's area of specialization is Family Medicine, and the corresponding taxonomy code that categorizes this field of practice is 207Q00000X.
On what date did the Logan Primary Care Service Corporation receive the assignment of its 1821105974 from the Centers for Medicare & Medicaid Services?
The Logan Primary Care Service Corporation was issued its 1821105974 by the Centers for Medicare & Medicaid Services on 2006-08-24.
As of what date were the details related to Logan Primary Care Service Corporation most recently updated or revised?
The information pertaining to Logan Primary Care Service Corporation, including its address, specialty, and other relevant details, was last updated or revised on 2007-11-29.