| Ico Primary Care, Llc | |
|
805 W Covell Rd Ste 200 Edmond OK 73003-2177 | |
| (405) 216-5373 | |
| Not Available |
| Full Name | Ico Primary Care, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 805 W Covell Rd Ste 200, Edmond, Oklahoma |
| Authorized Official Name and Position | Kevin M Penwell (PRESIDENT) |
| Authorized Official Contact | 4056006869 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ico Primary Care, Llc 5701 Se 74th St Ste E Oklahoma City OK 73135-1110 Ph: (405) 600-6869 | Ico Primary Care, Llc 805 W Covell Rd Ste 200 Edmond OK 73003-2177 Ph: (405) 216-5373 |
| NPI Number | 1811709363 |
|---|---|
| Provider Enumeration Date | 01/22/2025 |
| Last Update Date | 01/22/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811709363 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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