| Icco, Llc | |
|
1226 Virginia Ave North Bend OR 97459-2716 | |
| (541) 305-4224 | |
| (541) 998-4571 |
| Full Name | Icco, Llc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 1226 Virginia Ave, North Bend, Oregon |
| Authorized Official Name and Position | Erica Hauser (CFO) |
| Authorized Official Contact | 3125905372 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icco, Llc Po Box 4858 Portland OR 97208-4858 Ph: () - | Icco, Llc 1226 Virginia Ave North Bend OR 97459-2716 Ph: (541) 305-4224 |
| NPI Number | 1811570187 |
|---|---|
| Provider Enumeration Date | 05/04/2021 |
| Last Update Date | 06/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811570187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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