institution
Logan Primary Care
Medical Physician Assistant in Herrin, Illinois
NPI 1992951123

Logan Primary Care is a Medical Physician Assistant based in Herrin, IL and is specialized in Medical. Logan Primary Care practices in Herrin, IL. The NPI Number for Logan Primary Care is 1992951123 and holds a License No. 085-003043 (Illinois).

The current practice location address for Logan Primary Care is 405 Rushing Dr, Herrin, IL and can be reached out via phone at 618-993-3300 and via fax at 618-993-0262.

Location: 405 Rushing Dr, Herrin, IL, 62948-3730
institution
Provider Profile Details
NPI Number
1992951123
Provider Name
Logan Primary Care
Credential
Provider Entity Type
Organization
Address
405 Rushing Dr, Herrin, IL, 62948-3730
Phone Number
618-993-3300
Fax Number
618-993-0262
Provider Enumeration Date
08/07/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
080077375 01 IL RAILROAD MEDICARE
033308 01 IL HEALTHLINK
10019630 01 IL BLUE CROSS BLUE SHIELD
143870 05 IL
657869 01 IL HEALTHLINK
033308 01 IL HEALTH ALLIANCE
institution
Provider Business Practice Location Address Details
Address
405 Rushing Dr
City
State
Zip
62948-3730
Phone Number
618-993-3300
Fax Number
618-993-0262
person
Provider Business Mailing Address Details
Address
405 Rushing Dr
City
State
Zip
62948-3730
Phone Number
618-993-3300
Fax Number
618-993-0262
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
085-003043 (Illinois)
Definition
Definition to come...
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