Provider Demographics
NPI:1841304920
Name:COUNTY OF CROOK
Entity type:Organization
Organization Name:COUNTY OF CROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY JO
Authorized Official - Middle Name:LEDGERWOOD
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-477-6263
Mailing Address - Street 1:375 NW BEAVER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754
Mailing Address - Country:US
Mailing Address - Phone:541-447-5165
Mailing Address - Fax:541-477-3093
Practice Address - Street 1:375 NW BEAVER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754
Practice Address - Country:US
Practice Address - Phone:541-447-5165
Practice Address - Fax:541-477-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QA0005X
ORMD19870261QP0905X, 261QP0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No251B00000XAgenciesCase Management
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR043005Medicaid
OR054494Medicaid
OR320317Medicaid
OR043005Medicaid