Healthcare Provider Details

I. General information

NPI: 1588150981
Provider Name (Legal Business Name): CANYON MEDICAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 FILLMORE AVE
OGDEN UT
84401-2136
US

IV. Provider business mailing address

2265 FILLMORE AVE
OGDEN UT
84401-2136
US

V. Phone/Fax

Practice location:
  • Phone: 217-460-1768
  • Fax:
Mailing address:
  • Phone: 217-460-1768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSPEH W. NELSON
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 480-444-9940