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General NPI Number Information
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NPI Number | 1578645602
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Entity Type | Organization
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Legal Business Name | CANYON VIEW MEDICAL CENTER,LTD
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 601 N NAVAJO DR
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City | PAGE
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State | AZ
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Zip | 86040-7050
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Country | US
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Telephone | 928-645-8823
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Fax | 928-645-2524
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Provider Business Mailing Address
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Address Line | PO BOX 7050 601 N. NAVAJO DR.
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City | PAGE
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State | AZ
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Zip | 86040-7050
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Country | US
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Telephone | 928-645-8823
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Fax | 928-645-2524
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARRELL A BUNCH
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Credential | D.O.
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Telephone | 928-645-8823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1330
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License Number State | AZ
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