Logan Primary Care Service Corporation

NPI #1821105974 in Herrin, Illinois

Provider Information

NPI Number: 1821105974
Entity Type: Organization
Organization Name: Logan Primary Care Service Corporation
Primary Specialty: Family Medicine
Enumeration Date: Aug 24, 2006
Last Updated: Nov 29, 2007

Practice Location

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

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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