Provider Demographics
NPI:1093992810
Name:CROWN MEDICAL CENTER
Entity Type:Organization
Organization Name:CROWN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:IHIOMA
Authorized Official - Last Name:ONYEKABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-566-4535
Mailing Address - Street 1:7001 78TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2783
Mailing Address - Country:US
Mailing Address - Phone:763-566-4535
Mailing Address - Fax:
Practice Address - Street 1:7001 78TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2783
Practice Address - Country:US
Practice Address - Phone:763-566-4535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROWN MEDICAL CENTER, MINNEAPOLIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36657305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service