Icdoc LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ICDOC LLC

Practice address

2445 N Westwood Blvd Ste 100
Poplar Bluff, MO 63901-2317

Phone

(573) 776-0157

NPI assigned

Jul 6, 2023

Organization subpart

No

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

Authorized official

Name

Shelly Gresham, RN, NP-C

Title

Member, Administrator

Phone

(573) 776-0157

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kip Cardell Newell, D.O.

  • Anesthesiology Physician
  • Poplar Bluff, MO
  • NPI 1841226222
  NPD

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

{
    "created_epoch": "1688601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688601600000",
    "number": "1629756929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2445 N WESTWOOD BLVD STE 100",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012317",
            "telephone_number": "573-776-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2445 N WESTWOOD BLVD STE 100",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012317",
            "telephone_number": "573-776-0157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICDOC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-06",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A",
        "authorized_official_last_name": "GRESHAM",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "MEMBER, ADMINISTRATOR",
        "authorized_official_telephone_number": "573-776-0157",
        "authorized_official_credential": "RN, NP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise B Hutchinson
• Laurence Dow Hutchinson, M.D.
• Skye Marie Hutchison
• Kristal Renae Hutson, MSW
• Patrick Hyatt, PHARMD
• Independent Living Center of Southeast Missouri
• Independent Living Center of Southeast Missouri, Inc.
• Inman Chiropractic and Rehabilitation Center PLLC
• Joel Matthew Inman, D.C.
• Insightful Behavioral Health

• Primary Care Clinic/Center in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Primary Care Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; 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.