Ico Primary Care, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ICO PRIMARY CARE, LLC

Practice address

805 W Covell Rd Ste 200
Edmond, OK 73003-2177

Phone

(405) 216-5373

NPI assigned

Jan 22, 2025

Last updated

Jan 22, 2025By the provider in NPPES

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, DONPI 1841286333

Title

President

Phone

(405) 600-6869

Specialties & licenses 1

Addresses

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
  • Norman, OK
  • NPI 1417754334
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin M Penwell, DO

  • Emergency Medical Services (Emergency Medicine) Physician
  • Oklahoma City, OK
  • NPI 1841286333
  Authorized official Same address or phone

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

{
    "created_epoch": "1737504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1811709363",
    "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": "805 W COVELL RD STE 200",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730032177",
            "telephone_number": "405-216-5373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICO PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-22",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "PENWELL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "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": [],
    "endpoints": [],
    "other_names": []
}

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• Alyssa Denise Hwang
• Shannon Hysten
• Acheseopalima Ichi, LPN, CMT
• Id Eye LLC
• Idyll Behavioral Health Solutions
• Ie PLLC
• IHS Acquisition No. 100, Inc. (Bryant Nursing Center)
• Shanzay Ilyas

• Primary Care Clinic/Center in Edmond, OK
• Providers in Edmond, 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 Jan 22, 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.