NPI age
19 years
Enumerated 2006-09-06
● Active Type 2 · Organization
Canyon Lake Medical Clinic
Canyon Lake Medical Clinic is 1 of 689 clinic/center organizations in Texas.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Madison
Owner
Last NPPES update
2011-08-25
Source: monthly bulk 2026-05
How this organization compares
Across 689 active clinic/center providers in Texas.
NPI age
19 years
↑ 5 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2006 → 2026
2006-09Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
1356 Fm 2673
Canyon Lake, TX 781334510
Mailing address
1356 Fm 2673
Canyon Lake, TX 781334510
Authorized official
Jeff P Madison
Owner
📞 5124464500
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Robert Rodriguez, L.P.T. Physical Therapist NPI 1821056243
- Ingrid Thies, PT Physical Therapist NPI 1528875937
Specialties
-
Clinic/Center PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 164301703 | |
| 01 (TX) | 0022HN | BLUE CROSS/BLUE SHIELD |
| 05 (TX) | 164301702 | |
| 05 (TX) | 164301701 |
Practice context
Multi-provider organization. 2 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.