| Logan Primary Care Service Corporation | |
|
405 Rushing Drive Herrin IL 62948 | |
| (618) 993-3300 | |
| (618) 997-6626 |
| Full Name | Logan Primary Care Service Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 405 Rushing Drive, Herrin, Illinois |
| Authorized Official Name and Position | Tara G Deaton (ADMINISTRATOR) |
| Authorized Official Contact | 6189933300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Primary Care Service Corporation 405 Rushing Drive Herrin IL 62948 Ph: (618) 993-3300 | Logan Primary Care Service Corporation 405 Rushing Drive Herrin IL 62948 Ph: (618) 993-3300 |
| NPI Number | 1821105974 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 11/29/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821105974 | NPI | - | NPPES |
| 14D0666068 | Other | CLIA | |
| 143870 | Medicaid | IL | |
| 14D0436594 | Other | CLIA | |
| 14D0963522 | Other | CLIA | |
| 10019630 | Other | IL | BLUE CROSS BLUE SHIELD |
| 14D1041426 | Other | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036099669 (Illinois) | Primary |
William F Hays Md, Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3305 Logan Dr, Herrin, IL 62948 Phone: 618-997-4444 Fax: 618-993-1173 | |
A Pramote Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 Lincoln Drive, Herrin, IL 62948 Phone: 618-997-0166 | |
Timoteo Castro Md & Josefina D. Castro Md Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 321 South 13st St., Herrin, IL 62948 Phone: 618-942-7371 Fax: 618-942-8558 | |
Williamson County Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3303 Logan Dr, Herrin, IL 62948 Phone: 618-993-5767 Fax: 618-993-4005 | |
Herrin Clinic Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 220 S Park Ave, Herrin, IL 62948 Phone: 618-988-9777 Fax: 618-988-9097 | |
Logan Primary Care Service Corp. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 405 Rushing Drive, Herrin, IL 62948 Phone: 618-993-3300 Fax: 618-997-6626 | |
Logan Primary Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 405 Rushing Dr, Herrin, IL 62948 Phone: 618-993-3300 Fax: 619-997-6626 |