Icco, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ICCO, LLC

Practice address

3400 Cooperative Way
Lebanon, OR 97355-4063

Phone

(541) 666-3305

Fax

(541) 666-3306

NPI assigned

May 17, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Erica Hauser

Title

Cfo

Phone

(312) 590-5372

Specialties & licenses 1

Addresses

Other names 1

• BestMed Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1104490887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4858",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084858",
            "telephone_number": "541-500-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 COOPERATIVE WAY",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973554063",
            "telephone_number": "541-666-3305",
            "fax_number": "541-666-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-17",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "HAUSER",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "312-590-5372"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BestMed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Drew Garrett Hubbard, DMD
• Jourdan Leigh Hull, D.O.
• Justin Thomas Hull, D.O.
• Wendy Hull, LMFT
• Ashley Huynh
• Anna Louise Jacobi, NP
• Breyonna James
• Hannah M James, LMT
• Dante Jaramillo
• David John Jeffries

• Rural Health Clinic/Center in Lebanon, OR
• Providers in Lebanon, OR by specialty
• Rural Health Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.