NPIMap

Organization Active NPI

Icco LLC

  • Primary Care Clinic/Center
  • Springfield, OR
National Provider Identifier
1639612880
Registry record updated Nov 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ICCO LLC
Doing business as
Prime Care Partners
Practice address
5781 Main Street
Springfield, OR 97478
Phone
(541) 654-5245
Fax
(541) 844-1801
NPI assigned
Nov 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2016

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

Authorized official

Name
Peggy J Anderson
Title
Billing Office Manager
Phone
(541) 228-3865

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

5781 Main Street
Springfield, OR 97478

Mailing address

1292 High Street
Suite 224
Eugene, OR 97401
Phone (541) 228-3865

Other identifiers 1

IdentifierTypeStateIssuer
DP1360OtherORRR MEDICARE PTAN

Other names 1

  • Prime Care Partners Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Icco LLC15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479686400000",
    "number": "1639612880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 HIGH STREET",
            "address_2": "SUITE 224",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "97401",
            "telephone_number": "541-228-3865",
            "fax_number": "541-654-4693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5781 MAIN STREET",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "97478",
            "telephone_number": "541-654-5245",
            "fax_number": "541-844-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-21",
        "last_updated": "2016-11-21",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BILLING OFFICE MANAGER",
        "authorized_official_telephone_number": "541-228-3865"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "DP1360",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prime Care Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; 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.