FAITH MEDICAL CLINIC, PLLC
NPI 1417368168
Nurse Practitioner - Family in Canyon, TX
About Faith Medical Clinic, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FAITH MEDICAL CLINIC, PLLC (NPI 1417368168) is a healthcare organization registered as a family in Canyon, Texas and active in the NPI registry since May 2014. The organization holds a CLIA Waiver certificate valid through August 5, 2028 and lists Gloria R Fuller, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Faith Medical Clinic, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Faith Medical Clinic, PLLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 45D2082097
Faith Medical Clinic · Canyon, TXFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Faith Medical Clinic, PLLC's NPI number?
The NPI number for Faith Medical Clinic, PLLC is 1417368168. It was assigned to this organization in the NPPES registry on May 15, 2014.
Where is Faith Medical Clinic, PLLC located?
Faith Medical Clinic, PLLC is located at 1205 23rd St Ste 6, Canyon, TX 79015. The listed phone number is (806) 557-4674.
What is Faith Medical Clinic, PLLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Faith Medical Clinic, PLLC enrolled in Medicare?
Yes. Faith Medical Clinic, PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Faith Medical Clinic, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Faith Medical Clinic, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Faith Medical Clinic, PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 45D2082097) is associated with this NPI, valid through August 5, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Faith Medical Clinic, PLLC was last updated on September 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Faith Medical Clinic, Pllc · NPI 1417368168
Family organization in Canyon, Texas. Organization record, active in the CMS NPPES registry since May 15, 2014.
## Identity
- **NPI:** 1417368168 (Entity type: Organization)
- **Enumerated:** May 15, 2014
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Gloria Fuller, OWNER
## Practice location
- **Address:** 1205 23RD ST STE 6, Canyon, TX 79015-5331
- **Phone:** (806) 557-4674
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 8, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1417368168) · Data from the CMS NPPES public registry.