Logan Primary Care Service Corporation

LBN: Logan Primary Care Service Corporation
Logan Primary Care Service Corporation is an health care organization with primary practice located at 405 Rushing Dr , Herrin IL 62948. 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 Corporation can be contacted via phone (618) 993-3300, or through Deaton, Tara Gayel via phone (618) 993-3300.

Contact Information

Primary practice address
405 Rushing Dr Herrin IL 62948
Phone: (618) 993-3300
Fax: (618) 997-6626
Website:
Map and Directions
Authorized official contact:
Name: Deaton, Tara Gayel
Phone: (618) 993-3300

Health care specialties

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

Profile Details

NPI number 1730296880
LBN Legal business name Logan Primary Care Service Corporation
DBA Doing business as
Authorized official Deaton, Tara Gayel
Entity Organization
Organization subpart 1 No
Enumeration date Aug 24th, 2006
Last updated Apr 15th, 2008 - about 16 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 1730296880 NPPES
Illinois MEDICAID 143870

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