Southwest LTC Crockett I, LTD.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SOUTHWEST LTC CROCKETT I, LTD.

Doing business as

Whitehall Nursing Center

Practice address

1116 East Loop 304
Crockett, TX 75835-1810

Phone

(469) 916-6100

Fax

(469) 916-6105

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Ronald R. Payne

Title

Managing Member

Phone

(469) 916-6100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Whitehall Nursing Center Doing business as

Locations

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487726329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17760 PRESTON RD",
            "address_2": "SUITE 310",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752525663",
            "telephone_number": "469-916-6100",
            "fax_number": "469-916-6105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 EAST LOOP 304",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "469-916-6100",
            "fax_number": "469-916-6105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LTC CROCKETT I, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "469-916-6100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4428",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whitehall Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert Carlson MD PLLC
• Linnea Robison, LBSW, LNFA
• Bryan Scott Shaver, PA
• Mark Ray Sheets, FNP-C
• Frank A Smith, MD
• Southwest LTC Crockett II, LTD.
• Stanley Roger Speegle, MD
• Standley and Standley Enterprises LLC
• Cali Stapleton, NP
• Helen Joy Steel, LVN

• Skilled Nursing Facility in Crockett, TX
• Providers in Crockett, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.