Organization
CROCKETT MEDICAL CENTER, LLC
Active
Other names
Crockett Medical Center Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY EUGENE TJELMELAND (CEO)
(512) 617-7500
Entity
Organization
Contact information
Practice address
1050 E LOOP 304, CROCKETT, TX 75835
(936) 546-3890
Mailing address
4220 BULL CREEK RD, AUSTIN, TX 78731-6026
(512) 617-7500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
TX
207R00000X
Internal Medicine Physician
—
TX
207RC0000X
Cardiovascular Disease Physician
—
TX
207RI0011X
Interventional Cardiology Physician
—
TX
207X00000X
Orthopaedic Surgery Physician
—
TX
208800000X
Urology Physician
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
385139601
—
TX
05
—
385139602
—
TX
05
—
385139603
—
TX
Enumeration date
02/21/2018
Last updated
08/28/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us