Organization
ICO PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN M PENWELL DO (PRESIDENT, CMO)
(405) 600-6869
Entity
Organization
Contact information
Practice address
800 24TH AVE NW, NORMAN, OK 73069-6314
(405) 321-7100
Mailing address
5701 SE 74TH ST STE E, OKLAHOMA CITY, OK 73135-1110
(405) 600-6869
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201240380
—
OK
Enumeration date
02/27/2025
Last updated
02/27/2025
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