# ROBERT CROCKETT ENTERPRISE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Magnolia DME
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114201423
- **Authorized official:** DR. ROBERT S CROCKETT DPM (MEMBER)
- **Authorized official phone:** (601) 286-3745

## Contact information

- **Practice address:** 2310 4TH ST, SUITE A, MERIDIAN, MS 39301-5819
- **Practice address phone:** (601) 286-3745
- **Mailing address:** 2310 4TH ST, SUITE A, MERIDIAN, MS 39301-5819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 80193 | MS | Yes |

## Other

- **Enumeration date:** 10/05/2011
- **Last updated:** 10/05/2011