| Ico Primary Care Llc | |
|
800 24th Ave Nw Norman OK 73069-6314 | |
| (405) 321-7100 | |
| Not Available |
| Full Name | Ico Primary Care Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 800 24th Ave Nw, Norman, Oklahoma |
| Authorized Official Name and Position | Kevin M Penwell (PRESIDENT, CMO) |
| Authorized Official Contact | 4056006869 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ico Primary Care Llc 5701 Se 74th St Ste E Oklahoma City OK 73135-1110 Ph: (405) 600-6869 | Ico Primary Care Llc 800 24th Ave Nw Norman OK 73069-6314 Ph: (405) 321-7100 |
| NPI Number | 1417754334 |
|---|---|
| Provider Enumeration Date | 02/27/2025 |
| Last Update Date | 02/27/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417754334 | NPI | - | NPPES |
| 201240380 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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