Organization
COUNTY OF CROOK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY JO LEDGERWOOD HODGES MD (HEALTH OFFICER)
(541) 477-6263
Entity
Organization
Contact information
Practice address
375 NW BEAVER ST, SUITE 100, PRINEVILLE, OR 97754
(541) 447-5165
(541) 477-3093
Mailing address
375 NW BEAVER ST, SUITE 100, PRINEVILLE, OR 97754
(541) 447-5165
(541) 477-3093
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QA0005X
Ambulatory Family Planning Facility
—
—
261QP0904X
Federal Public Health Clinic/Center
Primary
MD19870
OR
261QP0905X
State or Local Public Health Clinic/Center
MD19870
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043005
—
OR
05
—
054494
—
OR
05
—
320317
—
OR
Enumeration date
08/18/2006
Last updated
07/27/2007
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