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General NPI Number Information
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NPI Number | 1104839703
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Entity Type | Organization
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Legal Business Name | CROCKETT MEDICAL CLINIC INC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 58 S. BELLS ST
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City | ALAMO
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State | TN
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Zip | 38001
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Country | US
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Telephone | 731-696-5401
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Fax | 731-696-5404
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Provider Business Mailing Address
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Address Line | 58 S. BELLS ST
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City | ALAMO
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State | TN
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Zip | 38001
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Country | US
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Telephone | 731-696-5401
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Fax | 731-696-5404
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Authorized Official
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Title or Position | CFO
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Name | RITA CROOM
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Credential |
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Telephone | 731-696-4670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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