Active NPI
Icco LLC
Doing business as Cottage Grove Medical Clinic
- Clinic/Center
- Cottage Grove, OR
National Provider Identifier
1750492906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- MD25942
- Legal business name
- ICCO LLC
- Doing business as
- Cottage Grove Medical Clinic
Cottage Grove Urgent Care - Practice address
- 1445 Gateway Blvd
Cottage Grove, OR 97424-1224 - Phone
- (541) 942-7000
- Fax
- (541) 942-5550
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Alexander K Morley, MD
- Title
- Medical Director
- Phone
- (541) 641-6053
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | MD25942 | OR | Primary |
| Clinic/Center | 261Q00000X | PA00462 | OR | |
| Clinic/Center | 261Q00000X | MD10106 | OR | |
| Clinic/Center | 261Q00000X | PA01017 | OR |
Addresses
Primary practice location
1445 Gateway Blvd
Cottage Grove, OR 97424-1224
Mailing address
1292 High Street
Suite 224
Eugene, OR 97401
Phone (541) 641-6053
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 150890 | Medicaid | OR | |
| 06691900 | Other | OR | BLUE CROSS/BLUE SHIELD |
Other names 2
- Cottage Grove Medical Clinic
- Cottage Grove Urgent Care
National Provider Directory
National Provider Directory- Tax ID family
- Icco LLC
Other organizations with this tax ID 14
Organizations that report the same tax identification number in the National Provider Directory.
-
- Primary Care Clinic/Center
- Eugene, OR
- NPI 1821549536
-
dba Pleasant Hill Medical Clinic
- Primary Care Clinic/Center
- Pleasant Hill, OR
- NPI 1922541184
-
dba Musculoskeletal Clinic
- Sports Medicine (Family Medicine) Physician
- Eugene, OR
- NPI 1437660768
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Cottage Grove, OR
- NPI 1578880548
-
- Family Medicine Physician
- Cottage Grove, OR
- NPI 1487784443
-
- Family Medicine Physician
- Cottage Grove, OR
- NPI 1225001720
-
- Physical Medicine & Rehabilitation Physician
- Cottage Grove, OR
- NPI 1093714701
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1529107200000",
"number": "1750492906",
"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": "541-641-6053",
"fax_number": "541-485-9987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1445 GATEWAY BLVD",
"city": "COTTAGE GROVE",
"state": "OR",
"postal_code": "974241224",
"telephone_number": "541-942-7000",
"fax_number": "541-942-5550"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ICCO LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-31",
"last_updated": "2018-06-16",
"status": "A",
"authorized_official_last_name": "MORLEY",
"authorized_official_first_name": "ALEXANDER",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "541-641-6053",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "OR",
"license": "MD25942",
"primary": true
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "OR",
"license": "PA00462",
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "OR",
"license": "MD10106",
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "OR",
"license": "PA01017",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "150890",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "06691900",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Cottage Grove Medical Clinic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Cottage Grove Urgent Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cottage Grove, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.