Canyon Lake Medical Clinic

LBN: Canyon Lake Medical Clinic
Canyon Lake Medical Clinic is an health care organization with primary practice located at 1356 Fm 2673 , Canyon Lake TX 78133-4510. The organization recently has only one registered license in Ambulatory Health Care Facilities / Rural Health, which is considered as the primary health care specialty. Canyon Lake Medical Clinic can be contacted via phone (830) 964-3019, or through Madison, Jeff P via phone (512) 446-4500.

Contact Information

Primary practice address
1356 Fm 2673 Canyon Lake TX 78133-4510
Phone: (830) 964-3019
Fax: (830) 226-5002
Website:
Map and Directions
Authorized official contact:
Name: Madison, Jeff P
Phone: (512) 446-4500

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rural Health 261QR1300X

Profile Details

NPI number 1124121009
LBN Legal business name Canyon Lake Medical Clinic
DBA Doing business as
Authorized official Madison, Jeff P
Entity Organization
Organization subpart 1 No
Enumeration date Sep 6th, 2006
Last updated Aug 25th, 2011 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124121009 NPPES
Texas MEDICAID 164301703
Texas Other 0022HN
Texas MEDICAID 164301702
Texas MEDICAID 164301701

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