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LOGAN PRIMARY CARE NPI 1992951123


NPI Information

NPI: 1992951123
Provider Name: LOGAN PRIMARY CARE
Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

Address:
405 RUSHING DR
HERRIN, IL
ZIP 62948
Phone: (618) 993-3300
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LOGAN PRIMARY CARE is a medical physician assistant in Herrin, IL. LOGAN PRIMARY CARE NPI is 1992951123. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

405 RUSHING DR
HERRIN, IL
ZIP 62948-730
Phone: (618) 993-3300
Fax: (618) 993-0262

The provider's authorized official is Micah Oakley .
The authorized official title is Physician Assistant and has the following contact phone number (618) 993-3300.

The enumeration date for this NPI number is 8/7/2008 and was last updated on 8/7/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedical085-003043ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
110019630OTHERILLINOISBLUE CROSS BLUE SHIELD
2C39531MEDICARE UPINILLINOIS
3143870MEDICAIDILLINOIS
4033308OTHERILLINOISHEALTH ALLIANCE
5033308OTHERILLINOISHEALTHLINK
6657869OTHERILLINOISHEALTHLINK
7080077375OTHERILLINOISRAILROAD MEDICARE
8336570MEDICARE PINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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