Healthcare Provider Details

I. General information

NPI: 1154514123
Provider Name (Legal Business Name): CANYON MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5969 E BROAD ST SUITE 200
COLUMBUS OH
43213-1546
US

IV. Provider business mailing address

5969 E BROAD ST SUITE 200
COLUMBUS OH
43213-1546
US

V. Phone/Fax

Practice location:
  • Phone: 614-864-6010
  • Fax:
Mailing address:
  • Phone: 614-864-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateOH

VIII. Authorized Official

Name: CARRIE FOSTER
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 614-864-6010