NPIMap

Organization Active NPI

Cross Medical Clinic PLLC

  • Family Nurse Practitioner
  • Canyon, TX
National Provider Identifier
1366879314
Registry record updated Oct 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
694365 Issued in TX
Legal business name
CROSS MEDICAL CLINIC PLLC
Practice address
1619 4TH Ave
Canyon, TX 79015-3824
Phone
(806) 418-5880
NPI assigned
Oct 6, 2013
Last updated
Oct 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2013

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

Authorized official

Name
Mrs. Gloria Rodriguez Fuller, FNP
Title
Owner
Phone
(806) 418-5880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 694365 TX Primary

Addresses

Primary practice location

1619 4TH Ave
Canyon, TX 79015-3824

Mailing address

PO Box 1614
Canyon, TX 79015-1614
Phone (806) 557-4138

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1381017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381708800000",
    "number": "1366879314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1614",
            "city": "CANYON",
            "state": "TX",
            "postal_code": "790151614",
            "telephone_number": "806-557-4138",
            "fax_number": "806-557-4165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 4TH AVE",
            "city": "CANYON",
            "state": "TX",
            "postal_code": "790153824",
            "telephone_number": "806-418-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSS MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-06",
        "last_updated": "2013-10-14",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_middle_name": "RODRIGUEZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "806-418-5880",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "694365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canyon, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2013; 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.