NPIMap

Organization Active NPI

Mid Coast Medical Center Crockett Inc

Doing business as Crockett Medical Center

  • Critical Access Hospital
  • Crockett, TX
National Provider Identifier
1114435260
Registry record updated Feb 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
MID COAST MEDICAL CENTER CROCKETT INC
Doing business as
Crockett Medical Center
Practice address
1100 E Loop 304
Crockett, TX 75835-1810
Phone
(512) 617-7505
NPI assigned
Jan 10, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

1100 E Loop 304
Crockett, TX 75835-1810

Mailing address

1100 E Loop 304
Crockett, TX 75835-1810
Phone (979) 543-6251

Other names 2

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180308001447 TX Part A Provider - Critical Access Hospital 3173884152 Receives reassigned benefits from 5 practitioners
Practice locations: Crockett, TX
O20180515000451 TX Part A Provider - Critical Access Hospital 3173884152 Receives reassigned benefits from 7 practitioners
Practice locations: Crockett, TX

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1114435260. Details of each certification follow.

Hospital certification: CCN 45Z393

Legal name
MID COAST MEDICAL CENTER CROCKETT INC
Doing business as
CROCKETT MEDICAL CENTER
Organization structure
Corporation
Incorporated
Oct 31, 2017 in TX
Enrollment address
1100 E Loop 304
Crockett, TX 75835-1810
Other Hospital Practice Location

Hospital certification: CCN 451393

Legal name
MID COAST MEDICAL CENTER CROCKETT INC
Doing business as
CROCKETT MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2019
Last certification
Feb 5, 2025
Beds
25
Ownership / control type
Physician ownership
Organization structure
Corporation
Incorporated
Oct 31, 2017 in TX
Enrollment address
1100 E Loop 304
Crockett, TX 75835-1810
Other Hospital Practice Location

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Crockett Medical CenterCCN 451393 · All quality measures
Type
Critical Access Hospitals
Ownership
Physician
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2149371Mid Coast Medical Center Crockett1100 East Loop 304, Crockett, TX 75835RegistrationAug 11, 2027

National Provider Directory

National Provider Directory

Locations

1050 E Loop 304
Crockett, TX 75835
Phone (936) 544-2236

Ownership & related parties

All disclosed owners & managing parties 4

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
Corporate DirectorChief Financial Officer Jul 1, 2025
W-2 Managing EmployeeChief Financial Officer Jul 1, 2025
Lisa Altenhoff Individual Corporate DirectorBusiness Office Director Jan 1, 2024
W-2 Managing EmployeeBusiness Office Director Jan 1, 2024
Brett Kirkham Individual Corporate DirectorCeo Oct 3, 2023
Mid Coast Health System Organization, El Campo, TX Management services company, For-profit Operational/Managerial Control Jan 1, 2024

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 7

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.

Affiliated clinicians 51

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771891200000",
    "number": "1114435260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E LOOP 304",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "979-543-6251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E LOOP 304",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "512-617-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID COAST MEDICAL CENTER CROCKETT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-10",
        "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": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crockett Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crockett Medical Center",
            "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.