NPIMap

Organization Active NPI

Logan Primary Care Service Corporation

  • Rural Health Clinic/Center
  • Herrin, IL
National Provider Identifier
1730296880
Registry record updated Apr 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LOGAN PRIMARY CARE SERVICE CORPORATION
Practice address
405 Rushing Dr
Herrin, IL 62948
Phone
(618) 993-3300
Fax
(618) 997-6626
NPI assigned
Aug 24, 2006
Last updated
Apr 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2008

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

Authorized official

Name
Mrs. Tara Gayel Deaton
Title
Administrator
Phone
(618) 993-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X IL Primary

Addresses

Primary practice location

405 Rushing Dr
Herrin, IL 62948

Mailing address

405 Rushing Dr
Herrin, IL 62948
Phone (618) 993-3300

Other identifiers 1

IdentifierTypeStateIssuer
143870MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Logan Primary Care5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208217600000",
    "number": "1730296880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 RUSHING DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-993-3300",
            "fax_number": "618-997-6626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 RUSHING DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-993-3300",
            "fax_number": "618-997-6626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN PRIMARY CARE SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2008-04-15",
        "status": "A",
        "authorized_official_last_name": "DEATON",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "GAYEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-993-3300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143870",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Herrin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; 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.