Organization
ICO PRIMARY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN M PENWELL DO (PRESIDENT)
(405) 600-6869
Entity
Organization
Contact information
Practice address
805 W COVELL RD STE 200, EDMOND, OK 73003-2177
(405) 216-5373
Mailing address
5701 SE 74TH ST STE E, OKLAHOMA CITY, OK 73135-1110
(405) 600-6869
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/22/2025
Last updated
01/22/2025
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