Organization
CROCKETT MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RITA CROOM (CFO)
(731) 696-4670
Entity
Organization
Contact information
Practice address
58 S. BELLS ST, ALAMO, TN 38001
(731) 696-5401
(731) 696-5404
Mailing address
58 S. BELLS ST, ALAMO, TN 38001
(731) 696-5401
(731) 696-5404
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3717707
PTAN
TN
05
—
3717707
—
TN
Enumeration date
08/14/2006
Last updated
08/01/2025
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