LOGAN PRIMARY CARE SERVICE CORPORATION (NPI# 1730296880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730296880 |
| Entity Type | Organization |
| Organization Name | LOGAN PRIMARY CARE SERVICE CORPORATION |
| Practice Address |
405 Rushing Dr Herrin IL 62948 |
| Practice Telephone | 6189933300 |
| Practice Fax Number | 6189976626 |
| Mailing Telephone | 6189933300 |
| Mailing Fax Number | 6189976626 |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2008-04-15 |
| Authorized Official Name | MRS. TARA GAYEL DEATON (ADMINISTRATOR) |
| Authorized Official Telephone | 6189933300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 143870 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821105974 | Logan Primary Care Service Corporation | Family Medicine | 405 Rushing Drive, Herrin, IL 62948 | 2006-08-24 |
| Street Address |
405 RUSHING DR |
| City | HERRIN |
| State | IL |
| Zip Code | 62948 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821102849 | Mark J Korte | Family Medicine | 405 Rushing Dr, Herrin, IL 62948-3730 | 2006-08-18 |
| 1932722196 | Kelli Jo Kirkpatrick | Nurse Practitioner | 405 Rushing Dr, Herrin, IL 62948-3730 | 2020-05-22 |
| 1538722202 | Kathy Sue Devous | Nurse Practitioner | 405 Rushing Dr, Herrin, IL 62948-3730 | 2019-04-18 |
| 1093227613 | Lenora Ann Levin | Social Worker | 405 Rushing Dr, Herrin, IL 62948-3730 | 2017-11-05 |
| 1003334459 | Whitney Mcguire | Nurse Practitioner | 405 Rushing Dr, Herrin, IL 62948-3730 | 2017-09-06 |
| 1619412475 | Jessica Lohman | Nurse Practitioner | 405 Rushing Dr, Herrin, IL 62948-3730 | 2017-01-03 |
| 1770032948 | Austin Michael Stallings | Physician Assistant | 405 Rushing Dr, Herrin, IL 62948-3730 | 2016-09-28 |
| 1649611252 | Charli Walter Leroy Smith Jr. | Family Medicine | 405 Rushing Dr, Herrin, IL 62948-3730 | 2013-07-11 |
| 1750632691 | Rachel L Terrill | Physician Assistant | 405 Rushing Dr, Herrin, IL 62948-3730 | 2012-10-01 |
| 1255681557 | Kallie M French | Physician Assistant | 405 Rushing Dr, Herrin, IL 62948-3730 | 2012-09-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215307590 | Carmelito Miralles Caronongan | Pediatrics | 120 S. 11th St., Herrin, IL 62948 | 2015-09-30 |
| 1073995684 | Motaz R Wraikat | Preventive Medicine | 315 S 13th St Ste 3, Herrin, IL 62948 | 2015-06-19 |
| 1639427933 | Salim Hosein | Surgery | 317 S 14th St Ste 1, Herrin, IL 62948 | 2012-08-17 |
| 1962780288 | Pooja Sareen | Internal Medicine | 3024 S Park Avenue, Herrin, IL 62948 | 2011-08-03 |
| 1235459918 | Timoteo Castro Md & Josefina D. Castro Md Ltd | Family Medicine | 321 South 13st St., Herrin, IL 62948 | 2010-06-04 |
| 1457501926 | Don Cassidy Arnold II | Urology | 220 S Park Ave Fl 2, Herrin, IL 62948 | 2008-09-22 |
| 1306094560 | Karl Keith Mitchener | Speech-Language Pathologist | 1901 N 13th Street, Herrin, IL 62948 | 2008-08-29 |
| 1457509705 | Kathryn Marie Bordenet-jines | Occupational Therapy Assistant | 1901 N. 13th, Herrin, IL 62948 | 2008-08-28 |
| 1417105776 | Cheryl Lynn Matic | Occupational Therapy Assistant | 1901 N. 13th St., Herrin, IL 62948 | 2008-08-28 |
| 1174771422 | Mary Frances Graham | Physical Therapy Assistant | 1901 N. 13th Street, Herrin, IL 62948 | 2008-08-28 |
| Find all providers in zip 62948 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396850616 | Logan Primary Care Service Corp. | Clinic/Center | 405 Rushing Drive, Herrin, IL 62948 | 2006-08-19 |
| 1477820900 | Southern Illinois Medical Services, Nfp | Clinic/Center | 405 Rushing Dr, Herrin, IL 62948-3730 | 2011-11-29 |
| 1326102716 | Rural Health, Inc | Clinic/Center | 3303 Logan Dr, Herrin, IL 62948-3732 | 2006-12-20 |
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|---|---|---|---|---|
| 1396386181 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak St Ste 100, Carbondale, IL 62901-1496 | 2019-10-02 |
| 1043872781 | Mendota Community Hospital | Clinic/Center | 1401 E 12th St Ste 400, Mendota, IL 61342-9216 | 2019-07-02 |
| 1114582913 | Hammond Henry Dist Hospital | Clinic/Center | 203 W Front St, Annawan, IL 61234-7756 | 2019-05-07 |
| 1841763810 | Heartland Women's Healthcare Ltd | Clinic/Center | 24 Veterans Dr, Harrisburg, IL 62946-3320 | 2019-01-02 |
| 1821561895 | Heartland Women's Healthcare Ltd | Clinic/Center | 215 N Logan St Ste A, West Frankfort, IL 62896-2314 | 2019-01-02 |
| 1578040275 | Osf Healthcare System | Clinic/Center | 230 S Exchange St, Galva, IL 61434-1871 | 2018-07-25 |
| 1700380219 | Toofan Medical Holdings, Ltd. | Clinic/Center | 1510 W Springfield Rd Ste A, Taylorville, IL 62568-2764 | 2018-03-20 |
| 1326542903 | Toofan Medical Holdings, Ltd. | Clinic/Center | 1001 Avenue of Mid America Ste 4, Effingham, IL 62401-4634 | 2018-03-20 |
| 1649795659 | Harrisburg Medical Center Inc | Clinic/Center | 3106 Outer Dr Ste 200, Marion, IL 62959-5270 | 2017-08-10 |
| 1588186308 | Wabash General Hospital District | Clinic/Center | 1430 College Dr Ste A, Mount Carmel, IL 62863-2649 | 2017-07-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.