Healthcare Provider Details

I. General information

NPI: 1457638223
Provider Name (Legal Business Name): CANYON VIEW MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W CENTER ST
SPANISH FORK UT
84660
US

IV. Provider business mailing address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. D. CURTIS PULSIPHER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 801-798-7301