MEDICARE: CROWN MEDICAL EQUIPMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	203000148	IL

General Provider Information

NPI Number	:	1447268396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN MEDICAL EQUIPMENT, INC.

Provider Business Mailing Address
First Line	:	2113 JOHNSON RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-3959
Country	:	US
Telephone Number	:	618-877-8800
Fax Number	:	618-877-8802

Provider Business Practice Location Address
First Line	:	2113 JOHNSON RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-3959
Country	:	US
Telephone Number	:	618-877-8800
Fax Number	:	618-877-8802

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. DANNY COX
Credential	:
Telephone Number	:	618-877-8800

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	10/17/2011

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