CROCKETT MEDICAL CLINIC INC NPI 1104839703

NPI Information

NPI: 1104839703
Provider Name: CROCKETT MEDICAL CLINIC INC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 44D0960161

Address:
58 S. BELLS ST
ALAMO, TN
ZIP 38001
Phone: (731) 696-5401
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CROCKETT MEDICAL CLINIC INC is a primary care clinic center in Alamo, TN. CROCKETT MEDICAL CLINIC INC NPI is 1104839703. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

58 S. BELLS ST
ALAMO, TN
ZIP 38001
Phone: (731) 696-5401
Fax: (731) 696-5404

The provider's authorized official is Charles Richard Jerman .
The authorized official title is Cfo and has the following contact phone number (731) 696-4670.

The CLIA number assigned to this NPI record is 44D0960161 - ambulance with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/14/2006 and was last updated on 7/2/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207Q00000X	Family Medicine		No
2	363L00000X	Nurse Practitioner		No
3	261QP2300X	Clinic/Center	Primary Care	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3717707	OTHER	TENNESSEE	PTAN
2	3717707	MEDICAID	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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