MEDICARE: MS. ELIZABETH RUTH HODGEN MHR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1972663953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH RUTH HODGEN MHR

Provider Business Mailing Address
First Line	:	1230 WINDSOR WAY
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73069-5339
Country	:	US
Telephone Number	:	405-329-3137
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 N FLOOD AVE
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73069-7642
Country	:	US
Telephone Number	:	405-321-3719
Fax Number	:	405-364-3209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	02/11/2010

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