CROCKETT MEDICAL CLINIC INC (NPI# 1104839703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104839703 |
Entity Type | Organization |
Organization Name | CROCKETT MEDICAL CLINIC INC |
Practice Address |
58 S. Bells St Alamo TN 38001 |
Practice Telephone | 7316965401 |
Practice Fax Number | 7316965404 |
Mailing Telephone | 7316965401 |
Mailing Fax Number | 7316965404 |
Enumeration Date | 2006-08-14 |
Last Update Date | 2019-07-02 |
Authorized Official Name | MR. CHARLES RICHARD JERMAN III (CFO) |
Authorized Official Telephone | 7316964670 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TN | PTAN | 3717707 | 01 |
TN | 3717707 | 05 |
Street Address |
58 S. BELLS ST |
City | ALAMO |
State | TN |
Zip Code | 38001 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902819501 | Karen B Webb | Nurse Practitioner | 58 S. Bells St, Alamo, TN 38001 | 2006-08-14 |
1548569700 | Kristin Lea Byrd | Nurse Practitioner | 58 S. Bells St, Alamo, TN 38001 | 2011-03-26 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649637281 | Megan Chapman | Nurse Practitioner | 18 N Cavalier Dr., Alamo, TN 38001 | 2016-01-27 |
1295906378 | Lori Faye Laman | Nurse Practitioner | 58 S. Bells St., Alamo, TN 38001 | 2008-03-17 |
1124234380 | Firstcare Medical Center, PC | Internal Medicine | 281-4 Climer Loop Road, Alamo, TN 38001 | 2007-05-15 |
1134264450 | State of Tennessee | Public Health or Welfare | 209 N Bells Street, Alamo, TN 38001 | 2007-02-21 |
1629154661 | Melvin Roy York | Pharmacist | 8 N. Cavalier Drive, Alamo, TN 38001 | 2006-10-31 |
1659384253 | Raymond Wayne Rhear | Family Medicine | 59 S. Bells St, Alamo, TN 38001 | 2006-08-14 |
1497807119 | Crockett County Nursing Home, Inc. | Skilled Nursing Facility | 580 West Main Street, Alamo, TN 38001-0367 | 2007-01-16 |
1790094795 | Shey Manning Whitby | Pharmacist | 1200 W Church St, Alamo, TN 38001-1320 | 2010-09-25 |
1467649624 | Freds Stores of Tennessee Inc | Durable Medical Equipment & Medical Supplies | 1104 W Church St, Alamo, TN 38001-1321 | 2007-10-01 |
1881100733 | Jeffrey Neal Nolen | Physical Therapist | 83 N Nance St, Alamo, TN 38001-1420 | 2017-12-14 |
Find all providers in zip 38001 |
Taxonomy Code | 261QP2300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Primary Care |
Definition to come... |
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---|---|---|---|---|
1861412777 | Alamo Navajo School Board, Inc. | Clinic/Center | Milepost 29, Highway 169, Alamo, NM 87825 | 2006-07-20 |
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1366080582 | Matthew E. Schantz, M.d. | Clinic/Center | 206 S Military St Ste 1, Loretto, TN 38469-2101 | 2019-12-18 |
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1023665403 | Elite Healthcare, LLC | Clinic/Center | 117 N 3rd St, Kingston, TN 37763-2842 | 2019-08-21 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.