Logan Primary Care Service Corp.

LBN: Logan Primary Care Service Corp.
Logan Primary Care Service Corp. is an health care organization with primary practice located at 502 W St Louis , West Frankfort IL 62896. The organization recently has only one registered license in Ambulatory Health Care Facilities / Rural Health, which is considered as the primary health care specialty. Logan Primary Care Service Corp. can be contacted via phone (618) 997-3400, or through Deaton, Tara G via phone (618) 993-3300.

Contact Information

Primary practice address
502 W St Louis West Frankfort IL 62896
Phone: (618) 997-3400
Fax: (618) 932-3797
Website:
Map and Directions
Authorized official contact:
Name: Deaton, Tara G
Phone: (618) 993-3300

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rural Health 261QR1300X 036099669 Illinois

Profile Details

NPI number 1023123346
LBN Legal business name Logan Primary Care Service Corp.
DBA Doing business as
Authorized official Deaton, Tara G
Entity Organization
Organization subpart 1 No
Enumeration date Aug 19th, 2006
Last updated Mar 16th, 2012 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023123346 NPPES
Illinois MEDICAID 148969
Illinois Other 10019630

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