CROCKETT MEDICAL CENTER LLC NPI 1487155990

NPI Information

NPI: 1487155990
Provider Name: CROCKETT MEDICAL CENTER, LLC

Doing Business As: CROCKETT MEDICAL CENTER CLINIC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
1050 E LOOP 304
CROCKETT, TX
ZIP 75835
Phone: (936) 546-3890
Get Directions

CROCKETT MEDICAL CENTER, LLC is a family medicine in Crockett, TX. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CROCKETT MEDICAL CENTER, LLC NPI is 1487155990. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Crockett Medical Center Clinic.

The provider's business location address is:

1050 E LOOP 304
CROCKETT, TX
ZIP 75835
Phone: (936) 546-3890

The provider's authorized official is Kelly Eugene Tjelmeland .
The authorized official title is Ceo and has the following contact phone number (512) 617-7500.

The enumeration date for this NPI number is 2/21/2018 and was last updated on 8/28/2018.

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	License State	Primary
1	207R00000X	Internal Medicine		TEXAS	No
2	207RC0000X	Internal Medicine	Cardiovascular Disease	TEXAS	No
3	207RI0011X	Internal Medicine	Interventional Cardiology	TEXAS	No
4	207X00000X	Orthopaedic Surgery		TEXAS	No
5	208800000X	Urology		TEXAS	No
6	207Q00000X	Family Medicine		TEXAS	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
1	385139602	MEDICAID	TEXAS
2	385139603	MEDICAID	TEXAS
3	385139601	MEDICAID	TEXAS

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: 5/5/2024

NPI Synchronization or Removal

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