Ico Primary Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ICO PRIMARY CARE LLC

Practice address

800 24TH Ave NW
Norman, OK 73069-6314

Phone

(405) 321-7100

NPI assigned

Feb 27, 2025

Organization subpart

No

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

Authorized official

Name

Kevin M Penwell, DO

Title

President, Cmo

Phone

(405) 600-6869

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Ico Primary Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ico Primary Care, LLC

  • Primary Care Clinic/Center
  • Edmond, OK
  • NPI 1811709363
  NPD tax ID

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

{
    "created_epoch": "1740614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1417754334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 SE 74TH ST STE E",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731351110",
            "telephone_number": "405-600-6869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 24TH AVE NW",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696314",
            "telephone_number": "405-321-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICO PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-27",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "PENWELL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT, CMO",
        "authorized_official_telephone_number": "405-600-6869",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201240380",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debbi Ibarra
• Ayooluwa Ibitayo
• Dorothy S Ibrahim, BHRS
• Joseph Ibrahim
• Sonia G. Ice, M.S. CCC-SLP
• Ideal Eye Care, P.C.
• Zain Iftikhar, MD
• Ignite Medical Resort Norman, LLC
• Prudencia A Ijeoma
• Josephine A. Ikpa

• Primary Care Clinic/Center in Norman, OK
• Providers in Norman, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; 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.