| Icc Medical Llc | |
|
405 S. L. Rogers Wells Blvd Glasgow KY 42141 | |
| (270) 834-8892 | |
| (270) 834-8899 |
| Full Name | Icc Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 405 S. L. Rogers Wells Blvd, Glasgow, Kentucky |
| Authorized Official Name and Position | Roger Todd Williams (OWNER) |
| Authorized Official Contact | 2708348892 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icc Medical Llc 405 S L Rogers Wells Blvd Glasgow KY 42141 Ph: (270) 834-8892 | Icc Medical Llc 405 S. L. Rogers Wells Blvd Glasgow KY 42141 Ph: (270) 834-8892 |
| NPI Number | 1891725743 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891725743 | NPI | - | NPPES |
| 000000486204 | Other | KY | ANTHEM BC/BS |
| 65945404 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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