Provider Demographics
NPI:1154380004
Name:CROCKETT KIDS PEDIATRICS, P.C.
Entity type:Organization
Organization Name:CROCKETT KIDS PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BENEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-762-3341
Mailing Address - Street 1:PO BOX A
Mailing Address - Street 2:320 CREWS STREET
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0016
Mailing Address - Country:US
Mailing Address - Phone:931-762-3341
Mailing Address - Fax:931-762-4577
Practice Address - Street 1:320 CREWS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4429
Practice Address - Country:US
Practice Address - Phone:931-762-3341
Practice Address - Fax:931-762-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty