ICCO LLC (NPI# 1053854208) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053854208 |
| Entity Type | Organization |
| Organization Name | ICCO LLC |
| Other Organization Name | PRIME CARE PARTNERS |
| Practice Address |
1740 Nw Goetz Street Roseburg OR 97471 |
| Mailing Address |
1292 High Street Suite 224 Eugene OR 97401 |
| Practice Telephone | 5416724885 |
| Practice Fax Number | 5416724782 |
| Mailing Telephone | 5412283865 |
| Mailing Fax Number | 5416544693 |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2019-07-16 |
| Authorized Official Name | PEGGY J ANDERSON (BILLING MANAGER) |
| Authorized Official Telephone | 5416724885 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | RR MEDICARE PTAN | DP1360 | 01 |
| Other Name | Type Code |
|---|---|
| Prime Care Partners | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922541184 | Icco LLC | Clinic/Center | 35859 Hwy 58, Pleasant Hill, OR 97455 | 2016-11-21 |
| 1639612880 | Icco LLC | Clinic/Center | 5781 Main Street, Springfield, OR 97478 | 2016-11-21 |
| 1235672478 | Icco LLC | Clinic/Center | 2710 Willamette Street, Eugene, OR 97405 | 2016-11-21 |
| 1922458371 | Icco LLC | Clinic/Center | 420 Smith St, Harrisburg, OR 97446 | 2016-06-16 |
| 1578928818 | Icco LLC | Clinic/Center | 1800 Coburg Road, Eugene, OR 97401 | 2015-12-30 |
| 1700251154 | Icco LLC | Physician Assistant | 1292 High Street, Suite 224, Eugene, OR 97401 | 2015-12-10 |
| 1740896547 | Icco LLC | Clinic/Center | 4480 Highway 101 Ste G, Florence, OR 97439-8831 | 2020-09-17 |
| 1649886441 | Icco LLC | Clinic/Center | 355 W 3rd Ave, Junction City, OR 97448-1313 | 2020-09-17 |
| 1063806842 | Icco LLC | Clinic/Center | 35859 Highway 58, Pleasant Hill, OR 97455-9651 | 2015-03-19 |
| 1821413881 | Icco LLC | Clinic/Center | 2710 Willamette St, Eugene, OR 97405-3238 | 2014-02-27 |
| Street Address |
1740 NW GOETZ STREET |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805660 | Rae Ann Barnes | Pharmacist | 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 | 2020-09-09 |
| 1023651031 | Colton Phillips | Behavioral Analyst | 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 | 2019-10-22 |
| 1952884876 | Meredith Krugel Lcsw PC | Clinic/Center | 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 | 2018-09-07 |
| 1114456563 | Philip Kaser Family, LLC | Pharmacy | 1175 W. Harvard Avenue, Roseburg, OR 97471 | 2017-06-08 |
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932551256 | Jonathan Schmidt | Licensed Practical Nurse | 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 | 2016-07-11 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1558784215 | Ginger Jean Thibedeau | Massage Therapist | 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 | 2014-01-30 |
| 1427303122 | Karishma Parekh | Internal Medicine | 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 | 2012-07-18 |
| 1245547744 | Centennial Medical Group West, LLC | Ophthalmology | 2801 Nw Mercy Dr., Ste. 340, Roseburg, OR 97471 | 2010-09-03 |
| Find all providers in zip 97471 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063611465 | Gordon F. Rose, PC | Clinic/Center | 544 W Umpqua St Ste 104, Roseburg, OR 97470-2999 | 2007-07-16 |
| 1205305190 | White Oak Medical Clinic LLC | Clinic/Center | 340 Nw Medical Loop, Roseburg, OR 97471-1645 | 2018-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376158774 | G&h Healthcare Inc | Clinic/Center | 17022 Sw Pacific Hwy Apt 210, Tigard, OR 97224-3400 | 2020-09-11 |
| 1750906509 | Alpha Care Family Medicine | Clinic/Center | 14455 Sw Allen Blvd Ste 100, Beaverton, OR 97005-4428 | 2020-06-08 |
| 1104447895 | Beyond Health LLC | Clinic/Center | 6440 Nw Mcmullen Ave, Portland, OR 97229-1158 | 2020-05-04 |
| 1851942536 | Careatc | Clinic/Center | 1101 W Main St Ste 103, Medford, OR 97501-2966 | 2019-09-24 |
| 1871153585 | Full Bloom Natural Medicine, LLC | Clinic/Center | 922 Nw Circle Blvd Ste 180, Corvallis, OR 97330-1483 | 2019-06-14 |
| 1831757475 | Structural Solutions Chiropractic | Clinic/Center | 121 Nw Everett St, Portland, OR 97209-4049 | 2019-05-29 |
| 1770147357 | Uptown Providers PC | Clinic/Center | 397 Warner Milne Rd, Oregon City, OR 97045-4045 | 2019-04-29 |
| 1720549058 | Barbara Gilbertson, Do, Inc. | Clinic/Center | 1803b Main St, Klamath Falls, OR 97601-2636 | 2019-03-28 |
| 1033674841 | Jeremy Mikolai Nd Inc | Clinic/Center | 2540 Ne M L King Blvd, Portland, OR 97212-3732 | 2019-02-06 |
| 1326531666 | Working Class Medicine LLC | Clinic/Center | 2133 N. Willis Blvd, Studio D, Portland, OR 97217 | 2018-06-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.