Healthcare Provider Details

I. General information

NPI: 1194102889
Provider Name (Legal Business Name): CANYON VIEW MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 WEST 100 NORTH
MONTICELLO UT
84535
US

IV. Provider business mailing address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-2559
  • Fax: 801-465-2590
Mailing address:
  • Phone: 801-798-7301
  • Fax: 801-798-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateUT

VIII. Authorized Official

Name: AARON LOWE
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-798-7301