MEDICARE: CANYON VIEW MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1225739857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANYON VIEW MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	336 W 100 S
Second Line	:
City	:	SPANISH FORK
State	:	UT
Zip	:	84660-5881
Country	:	US
Telephone Number	:	801-798-7301
Fax Number	:	801-798-8513

Provider Business Practice Location Address
First Line	:	591 N STATE ROAD 198 STE 202
Second Line	:
City	:	SALEM
State	:	UT
Zip	:	84653-5668
Country	:	US
Telephone Number	:	801-465-9802
Fax Number	:	801-798-8513

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	AARON LOWE
Credential	:
Telephone Number	:	801-210-2651

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	03/16/2023

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