Logan Primary Care

NPI #1194913541 in Herrin, Illinois

Provider Information

NPI Number: 1194913541
Entity Type: Organization
Organization Name: Logan Primary Care
Primary Specialty: Physician Assistant
Enumeration Date: Oct 11, 2007
Last Updated: Oct 11, 2007

Practice Location

Address: 405 RUSHING DR
City: Herrin
State: Illinois
ZIP Code: 62948-3730
Phone: (618) 993-3300

Authorized Official

Name: MRS. TARA DEATON
Title: ADMINISTRATOR
Phone: (618) 993-3300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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