Organization
ICP ALABAMA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY THOMASON (AUTHORIZED OFFICIAL)
(479) 498-6747
Entity
Organization
Contact information
Practice address
2700 CORPORATE DR STE 200, BIRMINGHAM, AL 35242-2733
(855) 498-6767
(479) 968-1673
Mailing address
PO BOX 9178, RUSSELLVILLE, AR 72811-9178
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/20/2018
Last updated
12/18/2020
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