| Icco, Llc | |
|
780 Nw Garden Valley Blvd Ste 310 Roseburg OR 97471-2298 | |
| (541) 672-4885 | |
| (541) 998-4571 |
| Full Name | Icco, Llc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 780 Nw Garden Valley Blvd Ste 310, Roseburg, 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 780 Nw Garden Valley Blvd Ste 310 Roseburg OR 97471-2298 Ph: (541) 672-4885 |
| NPI Number | 1194390385 |
|---|---|
| Provider Enumeration Date | 05/21/2021 |
| Last Update Date | 06/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194390385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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Icco Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1740 Nw Goetz Street, Roseburg, OR 97471 Phone: 541-672-4885 Fax: 541-672-4782 | |
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