| Crown Medical Support Services Clinic | |
|
1925 1st Ave S Minneapolis MN 55403-3724 | |
| (612) 978-3783 | |
| (612) 872-4343 |
| Full Name | Crown Medical Support Services Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1925 1st Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Joyce Ihioma Onyekaba (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6129783783 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crown Medical Support Services Clinic 1925 1st Ave S Minneapolis MN 55403-3724 Ph: (612) 978-3783 | Crown Medical Support Services Clinic 1925 1st Ave S Minneapolis MN 55403-3724 Ph: (612) 978-3783 |
| NPI Number | 1730546672 |
|---|---|
| Provider Enumeration Date | 01/22/2016 |
| Last Update Date | 02/26/2024 |
| Medicare PECOS PAC ID | 5597050542 |
|---|---|
| Medicare Enrollment ID | O20160830000899 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730546672 | NPI | - | NPPES |
| 957449200 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 36657 (Minnesota) | Primary |
| Provider Name | Nha P Nguyen |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1578595617 PECOS PAC ID: 3577467596 Enrollment ID: I20031121000373 |
| Provider Name | Joyce I Onyekaba |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720045271 PECOS PAC ID: 1850371238 Enrollment ID: I20040727000136 |
| Provider Name | Sumitra L Dorner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962692798 PECOS PAC ID: 8628262490 Enrollment ID: I20101105000388 |
| Provider Name | Sarah B Truso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871034645 PECOS PAC ID: 7113203563 Enrollment ID: I20170419001251 |
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