| Icco, Llc | |
|
2902 Tom Tennant Dr Woodburn OR 97071-2828 | |
| (971) 345-4767 | |
| (971) 345-4769 |
| Full Name | Icco, Llc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 2902 Tom Tennant Dr, Woodburn, 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 2902 Tom Tennant Dr Woodburn OR 97071-2828 Ph: (971) 345-4767 |
| NPI Number | 1255902557 |
|---|---|
| Provider Enumeration Date | 07/07/2021 |
| Last Update Date | 06/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255902557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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