Icco LLC

NPI #1205990041 in Oakridge, Oregon

Provider Information

NPI Number: 1205990041
Entity Type: Organization
Organization Name: Icco LLC
Primary Specialty: Clinic/Center
Enumeration Date: Dec 19, 2006
Last Updated: Jul 16, 2019

Practice Location

Address: 48134 HWY 58
City: Oakridge
State: Oregon
ZIP Code: 97463
Phone: (541) 782-4068

Authorized Official

Name: DR. DOUGLAS BAILEY, M.D.
Title: MEDICAL DIRECTOR - PRIMARY CARE
Phone: (541) 782-4068

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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