| Icco Llc | |
|
1445 Gateway Blvd Cottage Grove OR 97424-1224 | |
| (541) 942-7000 | |
| (541) 942-5550 |
| Full Name | Icco Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 1445 Gateway Blvd, Cottage Grove, Oregon |
| Authorized Official Name and Position | Alexander K Morley (MEDICAL DIRECTOR) |
| Authorized Official Contact | 5416416053 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icco Llc 1292 High Street Suite 224 Eugene OR 97401 Ph: (541) 641-6053 | Icco Llc 1445 Gateway Blvd Cottage Grove OR 97424-1224 Ph: (541) 942-7000 |
| NPI Number | 1750492906 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750492906 | NPI | - | NPPES |
| 150890 | Medicaid | OR | |
| 06691900 | Other | OR | BLUE CROSS/BLUE SHIELD |
Icco, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1445 Gateway Blvd, Cottage Grove, OR 97424 Phone: 541-942-7000 Fax: 541-998-4571 | |
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