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502 W Saint Louis St Ste 4 West Frankfort IL 62896-1968 | |
(618) 997-3400 | |
(618) 997-9324 |
Full Name | |
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Speciality | Clinic/Center |
Location | 502 W Saint Louis St Ste 4, West Frankfort, Illinois |
Authorized Official Name and Position | Warren P Ladner (SENIOR VP CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 6184575200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 3988 Carbondale IL 62902-3988 Ph: (618) 457-5200 | 502 W Saint Louis St Ste 4 West Frankfort IL 62896-1968 Ph: (618) 997-3400 |
NPI Number | 1215204938 |
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Provider Enumeration Date | 11/23/2011 |
Last Update Date | 01/07/2025 |
Medicare PECOS PAC ID | 3678677390 |
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Medicare Enrollment ID | O20120315000819 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215204938 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Illinois) | Primary |
Logan Primary Care Service Corp. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 502 W St Louis, West Frankfort, IL 62896 Phone: 618-997-3400 Fax: 618-932-3797 | |