# CROCKETT MEDICAL CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104839703
- **Authorized official:** RITA CROOM (CFO)
- **Authorized official phone:** (731) 696-4670

## Contact information

- **Practice address:** 58 S. BELLS ST, ALAMO, TN 38001
- **Practice address phone:** (731) 696-5401
- **Practice address fax:** (731) 696-5404
- **Mailing address:** 58 S. BELLS ST, ALAMO, TN 38001
- **Mailing address phone:** (731) 696-5401
- **Mailing address fax:** (731) 696-5404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/14/2006
- **Last updated:** 08/01/2025