Logan Primary Care
Physician Assistant in Herrin, IL. Organization (NPI-2).
NPI number1194913541
StatusActive
Last updated in NPPESOct 11, 2007
Details
- NPI
- 1194913541
- Entity type
- Organization (NPI-2)
- Legal business name
- Logan Primary Care
- Organization subpart
- No
- Enumeration date
- Oct 11, 2007
- Last updated
- Oct 11, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 85003043 | IL | Yes |
Practice location
405 Rushing DrHerrin, IL 62948-3730
Phone 618-993-3300 · Fax 618-997-6626
Mailing address
405 Rushing DrHerrin, IL 62948-3730
Phone 618-993-3300 · Fax 618-997-6626
Authorized official
Tara Deaton
Administrator
6189933300
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All 29 Physician Assistant providers in Herrin · All 524 providers in Herrin
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