Provider Demographics
NPI:1578937801
Name:CROSS COUNTRY HOLDINGS, P.C.
Entity Type:Organization
Organization Name:CROSS COUNTRY HOLDINGS, P.C.
Other - Org Name:OC MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-689-0123
Mailing Address - Street 1:1900 WASHINGTON BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6849
Mailing Address - Country:US
Mailing Address - Phone:801-612-1085
Mailing Address - Fax:801-337-1104
Practice Address - Street 1:1900 WASHINGTON BLVD
Practice Address - Street 2:STE 104
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-6849
Practice Address - Country:US
Practice Address - Phone:801-612-1085
Practice Address - Fax:801-337-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7387084-1202111N00000X
UT7387085-1202111N00000X
UT4891288-1204207Q00000X
UT9579184-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty