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General NPI Number Information
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NPI Number | 1366239725
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Entity Type | Organization
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Legal Business Name | MEDICAL CROWN LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 1611 WILLOWBY ST APT A
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City | COLUMBIA
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State | SC
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Zip | 29223-3317
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Country | US
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Telephone | 839-201-8661
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 WILLOWBY ST APT A
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City | COLUMBIA
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State | SC
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Zip | 29223-3317
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Country | US
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Telephone | 839-201-8661
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | SIGOURNEY HOLMES
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Credential | MZ8XP4HKEX
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Telephone | 839-201-8661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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