Healthcare Provider Details

I. General information

NPI: 1902131022
Provider Name (Legal Business Name): ICCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COBURG RD
EUGENE OR
97401-4945
US

IV. Provider business mailing address

PO BOX 1377 1800 COBURG ROAD
EUGENE OR
97440-1377
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-8760
  • Fax: 541-345-8763
Mailing address:
  • Phone: 541-345-8760
  • Fax: 541-345-8763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateOR

VIII. Authorized Official

Name: DR. ALEXANDER K MORLEY
Title or Position: MANAGER
Credential: M.D.
Phone: 541-636-3473