Organization
ICCO LLC
Active
Other names
Prime Care Partners
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY J ANDERSON (BILLING OFFICE MANAGER)
(541) 228-3865
Entity
Organization
Contact information
Practice address
5781 MAIN STREET, SPRINGFIELD, OR 97478
(541) 654-5245
(541) 844-1801
Mailing address
1292 HIGH STREET, SUITE 224, EUGENE, OR 97401
(541) 228-3865
(541) 654-4693
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DP1360
RR MEDICARE PTAN
OR
Enumeration date
11/21/2016
Last updated
11/21/2016
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