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ICDOC LLC
NPI 1629756929
Clinic/Center - Primary Care in Poplar Bluff, MO

Active since July 06, 2023
2445 N WESTWOOD BLVD STE 100, POPLAR BLUFF, MO 63901(573) 776-0157 Get Directions Write a Review

NPPES record last updated: July 6, 2023. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Icdoc Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ICDOC LLC (NPI 1629756929) is a healthcare organization registered as a primary care in Poplar Bluff, Missouri and active in the NPI registry since July 2023. The organization lists Shelly Gresham, Member, Administrator, as its authorized official.

NPPES Registry Identity

NPI1629756929
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameICDOC LLC
Location Address2445 N WESTWOOD BLVD STE 100Poplar Bluff, MO 63901-2317
Mailing Address2445 N Westwood Blvd Ste 100Poplar Bluff, MO 63901-2317 · (573) 776-0157
Phone(573) 776-0157
Organization SubpartNo
Authorized OfficialShelly GreshamMember, Administrator · (573) 776-0157
Enumeration DateJuly 6, 2023
NPPES CertifiedJuly 6, 2023
✔ NPI 1629756929 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
2445 N WESTWOOD BLVD STE 100, Poplar Bluff, MO 63901
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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KIP CARDELL NEWELL D.O.
Anesthesiology
2445 N WESTWOOD BLVD STE 100
POPLAR BLUFF, MO 63901
Butler County (573) 776-0157

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Icdoc LLC's NPI number?

The NPI number for Icdoc LLC is 1629756929. It was assigned to this organization in the NPPES registry on July 6, 2023.

Where is Icdoc LLC located?

Icdoc LLC is located at 2445 N Westwood Blvd Ste 100, Poplar Bluff, MO 63901. The listed phone number is (573) 776-0157.

What is Icdoc LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Icdoc LLC was last updated on July 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.