Provider Demographics
NPI:1225359417
Name:CROWN MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:CROWN MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMLO
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:NGASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-995-0944
Mailing Address - Street 1:8700 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7497
Mailing Address - Country:US
Mailing Address - Phone:713-995-0944
Mailing Address - Fax:713-995-0933
Practice Address - Street 1:8700 COMMERCE PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7497
Practice Address - Country:US
Practice Address - Phone:713-995-0944
Practice Address - Fax:713-995-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000032332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6463930001Medicare NSC