Provider Demographics
NPI:1326034638
Name:CROWN CARE MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:CROWN CARE MEDICAL PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-397-3776
Mailing Address - Street 1:9132 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3148
Mailing Address - Country:US
Mailing Address - Phone:727-397-3776
Mailing Address - Fax:727-397-3851
Practice Address - Street 1:9132 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-3148
Practice Address - Country:US
Practice Address - Phone:727-397-3776
Practice Address - Fax:727-397-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1470332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002228200Medicaid
FL1326034638OtherMEDICARE NPI
FL4283680001Medicare NSC