Provider Demographics
NPI:1114540382
Name:CROWN MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:CROWN MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-227-1677
Mailing Address - Street 1:393 DUNLAP ST N STE LL44
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4237
Mailing Address - Country:US
Mailing Address - Phone:612-227-1677
Mailing Address - Fax:651-340-3880
Practice Address - Street 1:393 DUNLAP ST N STE LL44
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4237
Practice Address - Country:US
Practice Address - Phone:612-227-1677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies