14D0436594 CLIA NUMBER - LOGAN PRIMARY CARE SOUTHERN ILLINOIS MEDICAL SERVICES

Laboratory Demographics

  • CLIA Code: 14D0436594
  • Facility Name: LOGAN PRIMARY CARE SOUTHERN ILLINOIS MEDICAL SERVICES
  • Facility Address: 405 RUSHING DR
    HERRIN, IL
    ZIP 62948
  • Facility Phone: (618) 993-3300
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: MARK D. KORTE
  • NPI Number: 1194913541
  • Taxonomy: 363A00000X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 14D0436594
LAB Type Rural Health Clinic
Facility Name LOGAN PRIMARY CARE SOUTHERN ILLINOIS MEDICAL SERVICES
Street 405 RUSHING DR
City HERRIN
State IL
ZIP 62948
Phone 6189933300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Rural Health Clinic
Lab Director MARK D. KORTE

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This page was last updated on: 5/18/2026