| Logan Primary Care Service Corp. | |
|
502 W St Louis West Frankfort IL 62896 | |
| (618) 997-3400 | |
| (618) 932-3797 |
| Full Name | Logan Primary Care Service Corp. |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 502 W St Louis, West Frankfort, Illinois |
| Authorized Official Name and Position | Tara G Deaton (ADMINISTRATOR) |
| Authorized Official Contact | 6189933300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Primary Care Service Corp. 405 Rushing Drive Herrin IL 62948 Ph: (618) 993-3300 | Logan Primary Care Service Corp. 502 W St Louis West Frankfort IL 62896 Ph: (618) 997-3400 |
| NPI Number | 1023123346 |
|---|---|
| Provider Enumeration Date | 08/19/2006 |
| Last Update Date | 03/16/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023123346 | NPI | - | NPPES |
| 148969 | Medicaid | IL | |
| 10019630 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 036099669 (Illinois) | Primary |
Southern Illinois Hospital Services Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2553 Ken Gray Blvd, West Frankfort, IL 62896 Phone: 618-932-3937 Fax: 618-932-2734 | |
Southern Illinois Medical Services, Nfp Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 502 W Saint Louis St Ste 4, West Frankfort, IL 62896 Phone: 618-997-3400 Fax: 618-997-9324 | |
Stacy Gardner Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 W Saint Louis St, West Frankfort, IL 62896 Phone: 618-932-2200 Fax: 618-932-2202 | |
Franklin Hospital District Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 309 W Saint Louis St Ste B, West Frankfort, IL 62896 Phone: 618-932-2200 Fax: 618-932-2202 | |
Health Plan Of Southern Illinois, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 309 W Saint Louis St, West Frankfort, IL 62896 Phone: 618-937-3526 Fax: 618-932-3619 | |
Advanced Surgical Technology, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 309 W Saint Louis St Ste A, West Frankfort, IL 62896 Phone: 618-932-9313 Fax: 618-932-9314 |