Provider Demographics
NPI:1700965464
Name:CROWN HEALTH CARE
Entity Type:Organization
Organization Name:CROWN HEALTH CARE
Other - Org Name:CONOVER FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-1239
Mailing Address - Country:US
Mailing Address - Phone:828-464-3821
Mailing Address - Fax:828-464-8994
Practice Address - Street 1:305 FIRST STREET EAST
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613
Practice Address - Country:US
Practice Address - Phone:828-464-3821
Practice Address - Fax:828-464-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2007-11-12
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
NC790148LMedicaid
NCCN8132OtherMEDICARE RAILROAD