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General NPI Number Information
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NPI Number | 1699869818
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Entity Type | Organization
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Legal Business Name | CROWN FAMILY PRACTICE PC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1113 INDEPENDENCE DR
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City | WEST PLAINS
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State | MO
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Zip | 65775
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Country | US
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Telephone | 417-256-8889
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Fax | 417-256-1649
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Provider Business Mailing Address
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Address Line | 1113 INDEPENDENCE DR
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City | WEST PLAINS
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State | MO
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Zip | 65775
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Country | US
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Telephone | 417-256-8889
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Fax | 417-256-1649
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Authorized Official
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Title or Position | PRESIDENT
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Name | STANLEY JOEL CROWN
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Credential | MD
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Telephone | 417-256-8889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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