ClinicBuilt
Book a call
Start a clinic / Texas

How to start a medical clinic in Texas.

What a founder needs to know in Texas: who can own a practice, which state approvals apply, how nurse practitioners and PAs can work, and where to register. Every fact links to its source.

Updated October 2026Sources linked
TXTexasStarting a clinic, at a glance
Corporate practice of medicine
StrictOwnership generally limited to licensed physicians
Certificate of need program
NoNo CON program for clinics
Nurse practitioner authority
Restricted practiceAANP classification
Register your business with
Texas Secretary of State
Checked October 2026

Ownership: Texas enforces a corporate practice of medicine prohibition, so a non-physician or a business owned by non-physicians generally cannot own a medical practice, employ physicians to treat patients, or collect fees for medical services, apart from narrow Texas Medical Board certified nonprofit health organizations.

Certificate of need: Texas does not have a Certificate of Need program, so physician offices, ASCs and imaging centers do not need CON approval.

Nurse practitioners: AANP classifies Texas as restricted practice: NPs must maintain career-long written protocols (a prescriptive authority agreement) with a delegating physician, one physician may delegate prescriptive authority to no more than seven NPs/APRNs or PAs (full-time equivalent) with some exemptions, and Schedule II prescribing is limited to certain settings.

Who can own a medical clinic in Texas

Texas enforces a corporate practice of medicine prohibition, so a non-physician or a business owned by non-physicians generally cannot own a medical practice, employ physicians to treat patients, or collect fees for medical services, apart from narrow Texas Medical Board certified nonprofit health organizations. Practices are usually physician-owned professional associations or PLLCs (physicians may also co-own with physician assistants, with physicians in majority control), and non-physician investors typically use a management services organization (MSO) that provides only non-clinical services for a fair market value fee.

Sources: hchlawyers.com, texas.public.law, tmb.state.tx.us

Business entity and registration

Physicians usually form a professional association (PA) or professional limited liability company (PLLC), which must be owned by licensed physicians (Texas Business Organizations Code 301.012 also allows minority physician assistant ownership with a physician organizer and physician control). Entities are filed with the Texas Secretary of State, which launched its SOSPortal filing system on September 29, 2026, replacing SOSDirect.

Sources: hchlawyers.com, texas.public.law, sos.state.tx.us

Certificate of need in Texas

Texas does not have a Certificate of Need program, so physician offices, ASCs and imaging centers do not need CON approval.

Sources: ncsl.org

Licenses, registrations and state agencies

Texas HHSC licenses specific facility types, including ambulatory surgical centers (Health and Safety Code Chapter 243) and freestanding emergency medical care facilities. Clinics where a majority of patients receive monthly prescriptions for opioids, benzodiazepines, barbiturates or carisoprodol must be certified as pain management clinics by the Texas Medical Board and be owned and operated by a Texas-licensed physician medical director.

Sources: hhs.texas.gov, hhs.texas.gov, texas.public.law, texas.public.law

Texas-specific requirements to know

Pain management clinics must hold a Texas Medical Board certificate before operating (application requires ownership proof, protocols and standing delegation orders). Prescribers must check the Texas Prescription Monitoring Program, run by the Texas State Board of Pharmacy, before prescribing opioids, benzodiazepines, barbiturates or carisoprodol. Physicians who delegate prescriptive authority to PAs or APRNs must register each supervision and delegation with the Texas Medical Board.

Sources: tmb.state.tx.us, tmb.texas.gov, tmb.state.tx.us

Agencies you will deal with

Nurse practitioners and physician assistants

Nurse practitioners: AANP classifies Texas as restricted practice: NPs must maintain career-long written protocols (a prescriptive authority agreement) with a delegating physician, one physician may delegate prescriptive authority to no more than seven NPs/APRNs or PAs (full-time equivalent) with some exemptions, and Schedule II prescribing is limited to certain settings.

Sources: aanp.org, storage.aanp.org, tmb.state.tx.us

Physician assistants: PAs practice under physician supervision, a prescriptive authority agreement must be in place for delegated prescribing, and the supervising physician must register the supervision and delegation with the Texas Medical Board.

Sources: tmb.state.tx.us

Med spas, injectables and IV therapy in Texas

The Texas Medical Board treats injectables, prescription cosmetic devices such as lasers, and IV hydration as the practice of medicine that a physician may delegate to qualified non-physicians under 22 TAC 169.25 and related rules: a physician, PA or APRN must be on site or immediately available, a practitioner-patient relationship must be established, written protocols must be signed and reviewed annually, and the delegating physician's name and license number must be posted. Because of the corporate practice rule, a med spa offering these services must be physician-owned or use an MSO structure, and esthetician ownership of a medical aesthetics practice is not permitted. Since September 1, 2025, HB 3749 (Jenifer's Law) limits elective IV therapy given outside a physician office or licensed facility to physicians, PAs, APRNs and RNs under physician supervision, with no delegation to unlicensed staff.

Sources: tmlt.org, law.cornell.edu, hchlawyers.com, polsinelli.com

Planning an aesthetic or IV business? See how to start a med spa and how to start an IV therapy business.

Step-by-step checklist in Texas

  1. Choose your structure and check ownership rules. Decide who will own the practice and confirm it fits Texas’s corporate practice of medicine rules. Texas enforces a corporate practice of medicine prohibition, so a non-physician or a business owned by non-physicians generally cannot own a medical practice, employ physicians to treat patients, or collect fees for medical services, apart from narrow Texas Medical Board certified nonprofit health organizations.
  2. Form the entity with the Texas Secretary of State. Physicians usually form a professional association (PA) or professional limited liability company (PLLC), which must be owned by licensed physicians (Texas Business Organizations Code 301.012 also allows minority physician assistant ownership with a physician organizer and physician control).
  3. Get federal numbers. Apply for an EIN from the IRS, then a Type 2 NPI for the practice and Type 1 NPIs for each clinician through NPPES.
  4. Confirm licenses with the Texas Medical Board. Every physician needs a Texas license. Check the board’s rules for any practice registrations, supervision agreements or office requirements before opening.
  5. Check certificate of need and facility licensing. Texas does not have a Certificate of Need program, so physician offices, ASCs and imaging centers do not need CON approval.
  6. Register to prescribe. Register with the DEA for controlled substances and complete any Texas controlled substance registration and prescription monitoring program enrollment. Pain management clinics must hold a Texas Medical Board certificate before operating (application requires ownership proof, protocols and standing delegation orders).
  7. Set up lab, safety and privacy basics. Get a CLIA certificate if you will run any lab tests, including waived tests, and put HIPAA privacy and security and OSHA policies in place.
  8. Enroll with Medicare, Medicaid and insurers. Enroll in Medicare through PECOS, enroll with Texas Medicaid (TMHP) and start commercial credentialing early, because payer enrollment often takes months.
  9. Plan staffing around NP and PA rules. AANP classifies Texas as restricted practice: NPs must maintain career-long written protocols (a prescriptive authority agreement) with a delegating physician, one physician may delegate prescriptive authority to no more than seven NPs/APRNs or PAs (full-time equivalent) with some exemptions, and Schedule II prescribing is limited to certain settings.
  10. Launch your marketing before opening day. Claim your Google Business Profile, publish a website with online booking and start ads and content four to eight weeks before you open, so the schedule is not empty on day one.

The national steps are explained in more detail in our guide to how to start a medical clinic, and costs are broken down in how much it costs to start a clinic.

Marketing a new clinic in Texas

New clinics usually fail on cash flow before they fail on care. The fastest fix is patients booked before opening day: a complete Google Business Profile, a website with online booking, local search ads and a few weeks of social content showing the team and the space. We run that launch for new clinics and keep it going once the doors open.

Plan your Texas launch with us →

Important. This guide is general information checked against official and professional sources in October 2026. It is not legal advice. Rules change and details depend on your services, so confirm your plan with a healthcare attorney licensed in Texas and with the agencies listed above.

Sources

  1. https://www.hchlawyers.com/blog/2026/june/texas-s-corporate-practice-of-medicine-prohibiti/
  2. https://texas.public.law/laws/tex._bus._orgs._code_section_301.012
  3. https://tmb.state.tx.us/page/non-profit-health-organizations
  4. https://www.sos.state.tx.us/corp/index.shtml
  5. https://www.ncsl.org/health/certificate-of-need-state-laws
  6. https://www.aanp.org/advocacy/texas
  7. https://storage.aanp.org/www/documents/no-index/state-fact-sheets/texas.pdf
  8. https://tmb.state.tx.us/page/supervision-and-prescriptive-delegation
  9. https://www.hhs.texas.gov/providers/health-care-facilities-regulation/ambulatory-surgical-centers
  10. https://www.hhs.texas.gov/providers/health-care-facilities-regulation/freestanding-emergency-medical-care-facilities
  11. https://texas.public.law/statutes/tex._occ._code_section_168.001
  12. https://texas.public.law/statutes/tex._occ._code_section_168.102
  13. https://www.tmlt.org/resource/regulations-for-medical-spas-in-texas
  14. https://www.law.cornell.edu/regulations/texas/22-Tex-Admin-Code-SS-169-25
  15. https://www.polsinelli.com/publications/new-texas-iv-therapy-law
  16. https://www.tmb.state.tx.us/apply-renew/other-permits-and-licenses/pain-management-clinics/pain-management-clinic-application-and-renewal
  17. https://www.tmb.texas.gov/249-prescription-monitoring-program-pmp-check-mandated-each-and-every-time-physician-or-authorized

Nearby state guides

New MexicoOklahomaArkansasLouisianaAll states
Texas questions

Starting a clinic in Texas, answered.

Can a non-physician own a medical clinic in Texas?
Texas enforces a corporate practice of medicine prohibition, so a non-physician or a business owned by non-physicians generally cannot own a medical practice, employ physicians to treat patients, or collect fees for medical services, apart from narrow Texas Medical Board certified nonprofit health organizations. Practices are usually physician-owned professional associations or PLLCs (physicians may also co-own with physician assistants, with physicians in majority control), and non-physician investors typically use a management services organization (MSO) that provides only non-clinical services for a fair market value fee.
Does Texas require a certificate of need to open a clinic?
Texas does not have a Certificate of Need program, so physician offices, ASCs and imaging centers do not need CON approval.
Can nurse practitioners open their own practice in Texas?
AANP classifies Texas as restricted practice: NPs must maintain career-long written protocols (a prescriptive authority agreement) with a delegating physician, one physician may delegate prescriptive authority to no more than seven NPs/APRNs or PAs (full-time equivalent) with some exemptions, and Schedule II prescribing is limited to certain settings.
Who can perform Botox, laser or IV therapy in Texas?
The Texas Medical Board treats injectables, prescription cosmetic devices such as lasers, and IV hydration as the practice of medicine that a physician may delegate to qualified non-physicians under 22 TAC 169.25 and related rules: a physician, PA or APRN must be on site or immediately available, a practitioner-patient relationship must be established, written protocols must be signed and reviewed annually, and the delegating physician's name and license number must be posted. Because of the corporate practice rule, a med spa offering these services must be physician-owned or use an MSO structure, and esthetician ownership of a medical aesthetics practice is not permitted. Since September 1, 2025, HB 3749 (Jenifer's Law) limits elective IV therapy given outside a physician office or licensed facility to physicians, PAs, APRNs and RNs under physician supervision, with no delegation to unlicensed staff.
Where do I register a medical practice in Texas?
Physicians usually form a professional association (PA) or professional limited liability company (PLLC), which must be owned by licensed physicians (Texas Business Organizations Code 301.012 also allows minority physician assistant ownership with a physician organizer and physician control). Entities are filed with the Texas Secretary of State, which launched its SOSPortal filing system on September 29, 2026, replacing SOSDirect.