NPIMap

Organization Active NPI

Logan Primary Care

  • Primary Care Nurse Practitioner
  • Herrin, IL
National Provider Identifier
1902094352
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
LOGAN PRIMARY CARE
Practice address
405 Rushing Dr
Herrin, IL 62948-3730
Phone
(618) 993-3300
Fax
(618) 932-3797
NPI assigned
Oct 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Authorized official

Name
Mrs. Tara G Deaton
Title
Administrator
Phone
(618) 997-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X IL Primary

Addresses

Primary practice location

405 Rushing Dr
Herrin, IL 62948-3730

Mailing address

502 E Saint Louis St
West Frankfort, IL 62896-1346
Phone (618) 993-3300

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": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1902094352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 E SAINT LOUIS ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628961346",
            "telephone_number": "618-993-3300",
            "fax_number": "618-932-3797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 RUSHING DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483730",
            "telephone_number": "618-993-3300",
            "fax_number": "618-932-3797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "DEATON",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-997-3400",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 11, 2007; 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.