Healthcare Provider Details

I. General information

NPI: 1184786352
Provider Name (Legal Business Name): CANYON VIEW MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 W MAIN ST
SANTAQUIN UT
84655-7083
US

IV. Provider business mailing address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

V. Phone/Fax

Practice location:
  • Phone: 801-754-3122
  • Fax: 801-754-0197
Mailing address:
  • Phone: 801-798-7301
  • Fax: 801-798-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. CURT PULISPHER
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-798-7301