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General NPI Number Information
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NPI Number | 1811513989
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Entity Type | Organization
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Legal Business Name | CAMROCK MEDICAL CLINIC, PLLC
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 602 N MAIN ST STE D
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City | ROCKDALE
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State | TX
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Zip | 76567-2323
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Country | US
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Telephone | 512-446-2277
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Fax | 512-548-9098
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Provider Business Mailing Address
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Address Line | 602 N MAIN ST
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City | ROCKDALE
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State | TX
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Zip | 76567-2323
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Country | US
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Telephone | 512-446-2277
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Fax |
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Authorized Official
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Title or Position | OWNER/ NP
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Name | TERRI BUCHANAN
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Credential | NP
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Telephone | 512-446-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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