Logan Primary Care Service Corp.

NPI 1023123346 - Clinic/Center - 261QR1300X

NPI Details
NPI 1023123346
Enumeration Date 08/19/2006
Last Updated 03/16/2012
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name TARA G TARA
Position ADMINISTRATOR
Phone (618) 997-3400
Fax (618) 932-3797
Practice Location
502 W ST LOUIS
WEST FRANKFORT IL, 62896, US
Phone (618) 997-3400
Fax (618) 932-3797
Business Location
405 RUSHING DRIVE
HERRIN IL, 62948, US
Phone (618) 993-3300
Fax (618) 997-6626
Toxanomy
Taxonomy Code 261QR1300X
License State Illinois
License Number 036099669
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According to our database, Logan Primary Care Service Corp. NPI is 1023123346, taxonomy code is 261QR1300X and license number is 036099669, license state is located at Illinois. Logan Primary Care Service Corp. physically located at 502 W St Louis, West Frankfort IL, 62896. NPI Number 1033115704 has the healthcare provider type.

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1023123346 NPI number is provided on an as is basis without warranty of any kind. 1023123346 is maintained by the National Plan & Provider Enumeration System. The contents of Logan Primary Care Service Corp. are for informational purposes only.