# CROCKETT HOSPITAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Loretto Family Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013574664
- **Authorized official:** KATHY TEAGUE (SECRETARY)
- **Authorized official phone:** (615) 920-7646

## Contact information

- **Practice address:** 722 N MILITARY ST, LORETTO, TN 38469-2336
- **Practice address phone:** (931) 853-6970
- **Practice address fax:** (931) 853-6974
- **Mailing address:** 330 SEVEN SPRINGS WAY, ATTEN: PROVIDER ENROLLMENT, BRENTWOOD, TN 37027
- **Mailing address phone:** (615) 920-7782

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/20/2019
- **Last updated:** 05/20/2019