=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265041370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CROWN BILLING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2020
-----------------------------------------------------
Last Update Date | 07/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10880 JOHN W ELLIOT DR., STE 700
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-838-3100
-----------------------------------------------------
Fax | 727-619-1610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10880 JOHN W ELLIOT DR., STE 700
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-838-3100
-----------------------------------------------------
Fax | 727-619-1610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ANDRA BOGDAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-838-3101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------