Canyon Lake Medical Clinic

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

CANYON LAKE MEDICAL CLINIC

Practice address

1356 FM 2673
Canyon Lake, TX 78133-4510

Phone

(830) 964-3019

Fax

(830) 226-5002

NPI assigned

Sep 6, 2006

Organization subpart

No

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

Authorized official

Name

Jeff P Madison

Title

Owner

Phone

(512) 446-4500

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314230400000",
    "number": "1124121009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1356 FM 2673",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781334510",
            "telephone_number": "830-964-3019",
            "fax_number": "830-226-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1356 FM 2673",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781334510",
            "telephone_number": "830-964-3019",
            "fax_number": "830-226-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON LAKE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2011-08-25",
        "status": "A",
        "authorized_official_last_name": "MADISON",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-446-4500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164301703",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "0022HN",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164301702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164301701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danny Lopez Campos, APRN, MSN, FNP-C
• Tammy Cantu, LPC
• Canyon Lake Dental PLLC
• Canyon Lake Family Dental Care, PLLC
• Canyon Lake Fire/EMS
• Canyon Lake Senior Home Care Inc.
• Camille Mari Coffey, LPC
• Christy Cole, LVN
• Comal County Emergency Services District 2
• Comal Vista Home Care, LLC

• Rural Health Clinic/Center in Canyon Lake, TX
• Providers in Canyon Lake, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; 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.