Provider Demographics
NPI:1588818942
Name:ICON CORP
Entity Type:Organization
Organization Name:ICON CORP
Other - Org Name:ICON MEDICAL ACCESSORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUKOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELISHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-931-6606
Mailing Address - Street 1:8030 CROWDER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-1063
Mailing Address - Country:US
Mailing Address - Phone:504-931-6606
Mailing Address - Fax:188-865-7111
Practice Address - Street 1:8030 CROWDER BLVD STE B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1063
Practice Address - Country:US
Practice Address - Phone:504-931-6606
Practice Address - Fax:188-865-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies