Organization
ICC MEDICAL LLC
Active
Other names
IMMEDIATE CARE CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER TODD WILLIAMS MD (OWNER)
(270) 834-8892
Entity
Organization
Contact information
Practice address
405 S. L. ROGERS WELLS BLVD, GLASGOW, KY 42141
(270) 834-8892
(270) 834-8899
Mailing address
405 S L ROGERS WELLS BLVD, GLASGOW, KY 42141
(270) 834-8892
(270) 834-8899
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000486204
ANTHEM BC/BS
KY
05
—
65945404
—
KY
Enumeration date
07/04/2006
Last updated
04/20/2008
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