Organization
ICCO, LLC
Active
Other names
Veneta Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN M HENNEMAN (BILLING CLERK)
(541) 935-2200
Entity
Organization
Contact information
Practice address
87983 TERRITORIAL RD, VENETA, OR 97487
(541) 935-2200
(541) 935-6241
Mailing address
PO BOX 145, VENETA, OR 97487
(541) 935-2200
(541) 935-6241
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054077
—
OR
Enumeration date
07/09/2006
Last updated
08/01/2016
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