Icco, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ICCO, LLC

Doing business as

BestMed

Practice address

186 W Ellendale Ave
Dallas, OR 97338-1408

Phone

(971) 900-4984

Fax

(971) 900-4977

NPI assigned

Apr 20, 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

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1619558640",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 W ELLENDALE AVE",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381408",
            "telephone_number": "971-900-4984",
            "fax_number": "971-900-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-20",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "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"
        }
    ]
}

• Jeffrey S Humphrey, D.O.
• Patrick F Hund, M.S. LPC
• Ashley Hunt
• Rachel Huntley, B.S.
• Brehauna Huston-Baker
• Tausha Lee Inara, MSW, CSWA
• Jennifer Indigo, AS, QMHA
• Karen Gail Jackson
• Connie Louise Jaeger, RN, WHCNP
• Keri Jaeger

• Rural Health Clinic/Center in Dallas, OR
• Providers in Dallas, 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 29, 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.