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General NPI Number Information
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NPI Number | 1871812594
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Entity Type | Organization
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Legal Business Name | CROWNE DIAGNOSTICS INC
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 300 STATE ST # 93504
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7668
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Country | US
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Telephone | 817-929-6051
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Fax | 817-442-8618
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Provider Business Mailing Address
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Address Line | PO BOX 93504
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City | SOUTHLAKE
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State | TX
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Zip | 76092-0114
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Country | US
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Telephone | 817-929-6051
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOE MORROW
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Credential | D.O.
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Telephone | 817-929-6051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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