Provider Demographics
NPI:1801816632
Name:ALBERT CROOK, DO
Entity Type:Organization
Organization Name:ALBERT CROOK, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-667-9400
Mailing Address - Street 1:1103 W. IRONWOOD DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COEUR D' ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2604
Mailing Address - Country:US
Mailing Address - Phone:208-667-9400
Mailing Address - Fax:208-667-2119
Practice Address - Street 1:1103 W. IRONWOOD DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:COEUR D' ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2604
Practice Address - Country:US
Practice Address - Phone:208-667-9400
Practice Address - Fax:208-667-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-1342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDS5452OtherBLUE CROSS OF IDAHO
ID000010138014OtherREGENCE BLUESHIELD OF ID
ID806409200Medicaid
IDS5452OtherBLUE CROSS OF IDAHO
ID000010138014OtherREGENCE BLUESHIELD OF ID