| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 883837 | (X3) Date Survey Completed 02/03/2021 |
| Name of Provider or Supplier Crossville Medical Clinic Rhc | Street Address, City, State 229 Interstate Drive Suite 105, Crossville, TN | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| J0000 | An initial Certification survey was conducted on 2/3/21, at Crossville Medical Clinic Rhc. Deficiencies were cited under 42 CFR 491 Subpart A - Conditions of Participation for Rural Health Clinics. |