Organization
ICCO LLC
Active
Other names
Cottage Grove Urgent Care, Cottage Grove Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER K MORLEY MD (MEDICAL DIRECTOR)
(541) 641-6053
Entity
Organization
Contact information
Practice address
1445 GATEWAY BLVD, COTTAGE GROVE, OR 97424-1224
(541) 942-7000
(541) 942-5550
Mailing address
1292 HIGH STREET, SUITE 224, EUGENE, OR 97401
(541) 641-6053
(541) 485-9987
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
MD10106
OR
261Q00000X
Clinic/Center
Primary
MD25942
OR
261Q00000X
Clinic/Center
PA00462
OR
261Q00000X
Clinic/Center
PA01017
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06691900
BLUE CROSS/BLUE SHIELD
OR
05
—
150890
—
OR
Enumeration date
08/31/2006
Last updated
06/16/2018
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