Provider Demographics
NPI:1598451239
Name:CROWN MEDICAL SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:CROWN MEDICAL SUPPORT SERVICES INC
Other - Org Name:CROWN MEDICAL 245G PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAMS COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIKE
Authorized Official - Middle Name:ORIZU
Authorized Official - Last Name:ONYEKABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-871-4354
Mailing Address - Street 1:1925 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3724
Mailing Address - Country:US
Mailing Address - Phone:612-978-3783
Mailing Address - Fax:612-354-7719
Practice Address - Street 1:1925 1ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3724
Practice Address - Country:US
Practice Address - Phone:612-978-3783
Practice Address - Fax:612-354-7719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1730546672
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-14
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care