Provider Demographics
NPI:1790747012
Name:CROWN MEDICAL CENTER
Entity Type:Organization
Organization Name:CROWN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKE
Authorized Official - Middle Name:
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:612-871-4354
Mailing Address - Fax:612-672-4343
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:612-871-4354
Practice Address - Fax:612-672-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN438R4CROtherBLUES
MN136548OtherUCARE
MN108584OtherHEALTHPARTNERS
MNA044153OtherMETROPOLITAN HEALTH PLAN
MN0407266OtherMEDICA