NPIMap

Organization Active NPI

Mid Coast Medical Center Crockett Inc

Doing business as Crockett Medical Center Clinic

  • Rural Health Clinic/Center
  • Crockett, TX
National Provider Identifier
1003303983
Registry record updated Feb 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MID COAST MEDICAL CENTER CROCKETT INC
Doing business as
Crockett Medical Center Clinic
Practice address
1050 E Loop 304 Ste 201
Crockett, TX 75835-1814
Phone
(936) 546-3890
NPI assigned
Apr 17, 2018
Last updated
Feb 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carrie Cornett
Title
Chief Financial Officer
Phone
(979) 543-6251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1050 E Loop 304 Ste 201
Crockett, TX 75835-1814

Mailing address

1050 E Loop 304 Ste 200
Crockett, TX 75835-1800
Phone (936) 546-3890

Other names 2

  • Crockett Medical Center Clinic Doing business as
  • Crockett Medical Center LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180516001255 TX Part A Provider - Rural Health Clinic 3173884152 Practice locations: Crockett, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003303983. Details of each certification follow.

Rural health clinic certification: CCN 673467

Legal name
MID COAST MEDICAL CENTER CROCKETT INC
Doing business as
CROCKETT MEDICAL CENTER CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 9, 2018
Last certification
Aug 9, 2018
Ownership / control type
1B
Organization structure
Corporation
Incorporated
Oct 31, 2017 in TX
Enrollment address
1050 E Loop 304
Ste 200
Crockett, TX 75835-1800
Related CCNs
451393

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17821/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-myrecord.cerner.com/r4/b4348b5b-bd9c-4bea-a3a3-0691137fbf46/

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carrie Cornett Individual Corporate DirectorChief Financial Officer Jul 20, 2025
W-2 Managing EmployeeChief Financial Officer Jul 20, 2025
Brett Kirkham Individual Corporate DirectorChief Executive Officer Oct 31, 2023
Operational/Managerial ControlChief Executive Officer Oct 31, 2023
Mid Coast Health System Organization, El Campo, TX Corporation Operational/Managerial Control Jan 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771891200000",
    "number": "1003303983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 E LOOP 304 STE 200",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351800",
            "telephone_number": "936-546-3890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 E LOOP 304 STE 201",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351814",
            "telephone_number": "936-546-3890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID COAST MEDICAL CENTER CROCKETT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2026-02-24",
        "certification_date": "2026-02-24",
        "status": "A",
        "authorized_official_last_name": "CORNETT",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "979-543-6251"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crockett Medical Center Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crockett Medical Center Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crockett Medical Center LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Crockett, TX

Sources for this page

Verify at the official NPI Registry.