Provider Demographics
NPI:1275722985
Name:CROWN COMPREHENSIVE HEADACHE CENTER
Entity Type:Organization
Organization Name:CROWN COMPREHENSIVE HEADACHE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCDARIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-533-5445
Mailing Address - Street 1:726 MADISON ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4407
Mailing Address - Country:US
Mailing Address - Phone:256-533-5445
Mailing Address - Fax:256-533-5449
Practice Address - Street 1:726 MADISON ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4407
Practice Address - Country:US
Practice Address - Phone:256-533-5445
Practice Address - Fax:256-533-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.15372261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00137167Medicare PIN