Provider Demographics
NPI:1679652564
Name:CROWN HEALTH CARE PA
Entity Type:Organization
Organization Name:CROWN HEALTH CARE PA
Other - Org Name:MEDICAL ARTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-465-9730
Mailing Address - Street 1:24 SECOND AVE, NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601
Mailing Address - Country:US
Mailing Address - Phone:828-328-2231
Mailing Address - Fax:828-323-1562
Practice Address - Street 1:24 SECOND AVE, NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:828-328-2231
Practice Address - Fax:828-323-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790148EMedicaid
NCCN8132OtherMEDICARE RAILROAD
NC790148EMedicaid