Organization
CROCKETT HOSPITAL LLC
Active
Other names
Loretto Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (SECRETARY)
(615) 920-7646
Entity
Organization
Contact information
Practice address
722 N MILITARY ST, LORETTO, TN 38469-2336
(931) 853-6970
(931) 853-6974
Mailing address
330 SEVEN SPRINGS WAY, ATTEN: PROVIDER ENROLLMENT, BRENTWOOD, TN 37027
(615) 920-7782
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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