| Icco Llc | |
|
2710 Willamette Street Eugene OR 97405 | |
| (541) 505-7317 | |
| (541) 505-7486 |
| Full Name | Icco Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2710 Willamette Street, Eugene, 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 2710 Willamette Street Eugene OR 97405 Ph: (541) 505-7317 |
| NPI Number | 1235672478 |
|---|---|
| Provider Enumeration Date | 11/21/2016 |
| Last Update Date | 06/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235672478 | NPI | - | NPPES |
| DP1360 | Other | OR | RR MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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