CROCKETT MEDICAL CENTER, LLC (NPI# 1114435260) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114435260 |
| Entity Type | Organization |
| Organization Name | CROCKETT MEDICAL CENTER, LLC |
| Other Organization Name | CROCKETT MEDICAL CENTER |
| Practice Address |
1100 E Loop 304 Crockett TX 75835-1810 |
| Mailing Address |
4220 Bull Creek Rd Austin TX 78731-6026 |
| Practice Telephone | 5126177505 |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2019-04-17 |
| Authorized Official Name | KELLY TJELMELAND (CEO) |
| Authorized Official Telephone | 5126177505 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 282N00000X | General Acute Care Hospital | Hospitals | ||
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
Hospitals |
| Other Name | Type Code |
|---|---|
| Crockett Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003303983 | Crockett Medical Center, LLC | Clinic/Center | 1050 E Loop 304 Ste 201, Crockett, TX 75835-1814 | 2018-04-17 |
| 1487155990 | Crockett Medical Center, LLC | Internal Medicine | 1050 E Loop 304, Crockett, TX 75835 | 2018-02-21 |
| Street Address |
1100 E LOOP 304 |
| City | CROCKETT |
| State | TX |
| Zip Code | 75835-1810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073500799 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2005-09-29 |
| 1194334532 | Patrick Allen Harvey | Pharmacist | 1100 E Loop 304, Crockett, TX 75835-1810 | 2020-07-30 |
| 1700269941 | Timberlands Healthcare, LLC | Medicare Defined Swing Bed Unit | 1100 E Loop 304, Crockett, TX 75835-1810 | 2015-07-07 |
| 1306223458 | Timberlands Healthcare, LLC | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2015-04-28 |
| 1013301647 | Lifeguard Ambulanceservice of Texas, LLC | Ambulance | 1100 E Loop 304, Crockett, TX 75835-1810 | 2015-03-20 |
| 1588957856 | Walter Cody Cox | Emergency Medicine | 1100 E Loop 304, Crockett, TX 75835-1810 | 2011-05-19 |
| 1083835219 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2007-05-02 |
| 1326101692 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2006-12-18 |
| 1831251479 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2006-12-13 |
| 1912081290 | East Texas Medical Center Crockett | Long Term Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2006-10-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568012862 | Ruby R. Adler | Technician | 2301 N 4th Street, Crockett, TX 75835 | 2019-09-18 |
| 1366712978 | Traditions Hospice of Madisonville, LLC | Hospice Care, Community Based | 600e Loop 304, Crockett, TX 75835 | 2012-01-12 |
| 1538458633 | Northeast Texas Home Health Agency Ltd | Home Health | 2001 E Houston Ave, Crockett, TX 75835 | 2011-03-30 |
| 1508096553 | D&c Medical Associates | Family Medicine | 1100 Loop 3048 East, Suite 200, Crockett, TX 75835 | 2009-07-23 |
| 1356466346 | John Vernon Garner | Dentist | 102 North Grace, Crockett, TX 75835 | 2007-03-20 |
| 1023148467 | Houston County Home Health Care, Inc. | Durable Medical Equipment & Medical Supplies | 1703 E Hwy 21 E, Crockett, TX 75835 | 2007-03-06 |
| 1407944382 | Davy Crockett Drug, Inc. | Pharmacy | 107 S 4th St, Crockett, TX 75835 | 2006-10-10 |
| 1437177052 | John Allan Burnett | Emergency Medicine | 1100 Loop 340 E, Crockett, TX 75835 | 2006-07-18 |
| 1720022593 | Stanley Roger Speegle | Family Medicine | 1100 Loop 304 East, Crockett, TX 75835 | 2006-06-15 |
| 1649219809 | Jeanne M. Hopple | Nurse Practitioner | The Heart Institute of East Texas, Crocket, 951 E. Loop 304, Crockett, TX 75835 | 2006-06-05 |
| Find all providers in zip 75835 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326101692 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2006-12-18 |
| 1831251479 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2006-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629514203 | Tmc Bonham Hospital | General Acute Care Hospital | 504 Lispcomb Blvd, Bonham, TX 75418 | 2017-01-06 |
| 1164772216 | Methodist West Houston Hospital | General Acute Care Hospital | 5807 Grand Saline Dr, Richmond, TX 77469-6173 | 2012-09-17 |
| 1528367356 | Liberty County Hospital District No 1 | General Acute Care Hospital | 1353 N Travis, Liberty, TX 77575-3549 | 2011-03-18 |
| 1669613105 | Kingsbrook Jewish Medical Center | General Acute Care Hospital | 1404 Savoy Ct, Colleyville, TX 76034-6267 | 2009-03-12 |
| 1578724811 | Vaishali Kawaduji Bhusari | General Acute Care Hospital | 4555 Lorraine Ave, Dallas, TX 75205-3612 | 2008-06-19 |
| 1548457682 | Audie Murphy Va Hospital | General Acute Care Hospital | 4041 Merton Minter, San Antonio, TX 78229 | 2007-10-03 |
| 1033309323 | George Daniel Williamson | General Acute Care Hospital | 5087 E State Highway 22, Hamilton, TX 76531-1355 | 2007-08-01 |
| 1396861324 | Dr. Carlos F. Morales Md. | General Acute Care Hospital | 4414 Centerview Dr., Ste 168, San Antonio, TX 78228-1404 | 2007-03-21 |
| 1780786699 | Palacios Community Medical Center | General Acute Care Hospital | 311 Green Ave, Palacios, TX 77465-3213 | 2006-09-01 |
| 1033229778 | Va Hospital | General Acute Care Hospital | 8222 Lone Bridge Ln, Humble, TX 77338-1726 | 2006-08-30 |
| Find all providers with the same taxonomy | ||||
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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.