| Canyon Lake Medical Clinic | |
|
1356 Fm 2673 Canyon Lake TX 78133-4510 | |
| (830) 964-3019 | |
| (830) 226-5002 |
| Full Name | Canyon Lake Medical Clinic |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 1356 Fm 2673, Canyon Lake, Texas |
| Authorized Official Name and Position | Jeff P Madison (OWNER) |
| Authorized Official Contact | 5124464500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Lake Medical Clinic 1356 Fm 2673 Canyon Lake TX 78133-4510 Ph: (830) 964-3019 | Canyon Lake Medical Clinic 1356 Fm 2673 Canyon Lake TX 78133-4510 Ph: (830) 964-3019 |
| NPI Number | 1124121009 |
|---|---|
| Provider Enumeration Date | 09/06/2006 |
| Last Update Date | 08/25/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124121009 | NPI | - | NPPES |
| 164301703 | Medicaid | TX | |
| 0022HN | Other | TX | BLUE CROSS/BLUE SHIELD |
| 164301702 | Medicaid | TX | |
| 164301701 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Innate Ability Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1742 Fm 2673, Canyon Lake, TX 78133 Phone: 830-964-3032 Fax: 830-964-4460 | |
Windmill Wellness Ranch Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 26229 N Cranes Mill Rd, Canyon Lake, TX 78133 Phone: 830-935-2800 |