Organization
ICCO LLC
Active
Other names
Eugene Urgent Care
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN LAVERN HUNSUCKER (DIRECTOR OF OPERATIONS)
(541) 521-7222
Entity
Organization
Contact information
Practice address
1292 HIGH STREET, SUITE 224, EUGENE, OR 97401
(541) 345-8760
(541) 345-8763
Mailing address
1292 HIGH ST, SUITE 224, EUGENE, OR 97401-3238
(541) 345-2860
(541) 345-8763
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA175527
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA175527
OREGON MEDICAL BOARD STATE LICENSE FOR PHYSICIAN ASSISTANT
OR
Enumeration date
12/10/2015
Last updated
12/10/2015
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