| Ico Primary Care, Llc | |
|
1664 S Choctaw Rd Ste 101 Choctaw OK 73020-6767 | |
| (405) 281-2144 | |
| Not Available |
| Full Name | Ico Primary Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1664 S Choctaw Rd Ste 101, Choctaw, Oklahoma |
| Authorized Official Name and Position | Kevin Penwell (CMO) |
| Authorized Official Contact | 4056006869 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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 1664 S Choctaw Rd Ste 101 Choctaw OK 73020-6767 Ph: (405) 281-2144 |
| NPI Number | 1568144996 |
|---|---|
| Provider Enumeration Date | 08/04/2023 |
| Last Update Date | 07/24/2025 |
| Medicare PECOS PAC ID | 6901240910 |
|---|---|
| Medicare Enrollment ID | O20240219000460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568144996 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kevin M Penwell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841286333 PECOS PAC ID: 8325005580 Enrollment ID: I20041220000487 |
| Provider Name | Jeremy George Tanner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275874026 PECOS PAC ID: 5991944761 Enrollment ID: I20130627000237 |
| Provider Name | Kristi Cooksey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265071922 PECOS PAC ID: 7315377637 Enrollment ID: I20200428000867 |
| Provider Name | Kelli Le Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902370802 PECOS PAC ID: 6709278815 Enrollment ID: I20220124001394 |
| Provider Name | Josephine R Otoo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477064335 PECOS PAC ID: 5890865190 Enrollment ID: I20230419000092 |
| Provider Name | Becky Joann Pata |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629504683 PECOS PAC ID: 0840642682 Enrollment ID: I20240117003969 |
Cary Carpenter, M.d. P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15809 Ne 23rd St, Choctaw, OK 73020 Phone: 405-390-9600 Fax: 405-390-9400 | |
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Choctaw Wellness Enterprises, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15803 Ne 23rd St, Choctaw, OK 73020 Phone: 405-390-9600 Fax: 405-390-9400 | |
Bruce A. Stafford, Do, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15809 Ne 23rd St, Choctaw, OK 73020 Phone: 405-390-4280 Fax: 405-390-4282 | |
Gregory P. Kelley D.o. Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13190 Ne 23rd Street, Choctaw, OK 73020 Phone: 405-769-7201 Fax: 405-769-4034 | |
Ruffin Medicine Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1940 Harper St, Choctaw, OK 73020 Phone: 405-281-6065 Fax: 405-281-6068 |