Ico Primary Care, Llc | |
1664 S Choctaw Rd Ste 101 Choctaw OK 73020-6767 | |
(405) 281-2144 | |
Not Available |
Full Name | Ico Primary Care, Llc |
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Speciality | Clinic/Center |
Location | 1664 S Choctaw Rd Ste 101, Choctaw, Oklahoma |
Authorized Official Name and Position | Kevin Penwell (CMO) |
Authorized Official Contact | 4056006869 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Ico Primary Care, Llc 5701 Se 74th St Ste E Oklahoma City OK 73135-1110 Ph: (405) 600-6869 | Ico Primary Care, Llc 1664 S Choctaw Rd Ste 101 Choctaw OK 73020-6767 Ph: (405) 281-2144 |
NPI Number | 1568144996 |
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Provider Enumeration Date | 08/04/2023 |
Last Update Date | 06/18/2024 |
Medicare PECOS PAC ID | 6901240910 |
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Medicare Enrollment ID | O20240219000460 |
Identifier | Type | State | Issuer |
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1568144996 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Kevin M Penwell |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1841286333 PECOS PAC ID: 8325005580 Enrollment ID: I20041220000487 |
Provider Name | Jeremy George Tanner |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275874026 PECOS PAC ID: 5991944761 Enrollment ID: I20130627000237 |
Provider Name | Kelli Le Cox |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902370802 PECOS PAC ID: 6709278815 Enrollment ID: I20220124001394 |
Provider Name | Josephine R Otoo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477064335 PECOS PAC ID: 5890865190 Enrollment ID: I20230419000092 |
Healthcare Express, Llp Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 14321 Ne 23rd Street, Choctaw, OK 73020 Phone: 405-342-0255 | |
Ruffin Medicine Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1940 Harper St, Choctaw, OK 73020 Phone: 405-281-6065 Fax: 405-281-6068 |