Organization Name: | ICCO LLC |
NPI Number: | 1063806842 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALEXANDER K MORLEY (MEDICAL DIRECTOR) |
Mailing Address: | 35859 Highway 58 Pleasant Hill |
State: | OR US |
Postal Code: | 974559651 |
Phone Number: | 5413458760 |
Fax Number: | 5413458763 |
NPI Enumeration Date: | 03/19/2015 |
NPI Last Update Date: | 03/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |