NPIMap

Organization Active NPI

John a. Logan College

  • Dentist
  • Carterville, IL
National Provider Identifier
1598055741
Registry record updated Apr 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.018274 Issued in IL
Legal business name
JOHN A. LOGAN COLLEGE
Practice address
700 Logan College Dr
Carterville, IL 62918-2500
Phone
(618) 985-2828
Fax
(618) 985-4654
NPI assigned
Apr 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Pam Ruth Karns, RDH, MS
Title
Department Chair for Allied Health
Phone
(618) 985-2828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019.018274 IL Primary

Addresses

Primary practice location

700 Logan College Dr
Carterville, IL 62918-2500

Mailing address

700 Logan College Dr
Carterville, IL 62918-2500
Phone (618) 985-2828

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302220800000",
    "number": "1598055741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 LOGAN COLLEGE DR",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629182500",
            "telephone_number": "618-985-2828",
            "fax_number": "618-985-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 LOGAN COLLEGE DR",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629182500",
            "telephone_number": "618-985-2828",
            "fax_number": "618-985-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN A. LOGAN COLLEGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-08",
        "last_updated": "2011-04-08",
        "status": "A",
        "authorized_official_last_name": "KARNS",
        "authorized_official_first_name": "PAM",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "DEPARTMENT CHAIR FOR ALLIED HEALTH",
        "authorized_official_telephone_number": "618-985-2828",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RDH, MS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.018274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carterville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.