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NPI Code Detail

MEDICARE: BLACK CANYON COMMUNITY HEALTH CENTER

MEDICARE: BLACK CANYON COMMUNITY HEALTH CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician3297AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679723217
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACK CANYON COMMUNITY HEALTH CENTER
Provider Business Mailing Address
First Line : PO BOX 1958
Second Line :
City : BLACK CANYON CITY
State : AZ
Zip : 85324-1958
Country : US
Telephone Number : 623-374-0200
Fax Number :
Provider Business Practice Location Address
First Line : 19251 E OASIS DR
Second Line :
City : BLACK CANYON CITY
State : AZ
Zip : 85324-8878
Country : US
Telephone Number : 623-374-0200
Fax Number : 623-374-5576
Authorized Official
Title or Position : CEO
Name : RANDY CHARLES HANCOCK
Credential :
Telephone Number : 623-374-0200
Provider Enumeration Date : 09/19/2008
Last Update Date : 07/08/2022

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Practice Location Address:
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85324-8878
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Practice Fax: 623-374-5576

Directions to “BLACK CANYON COMMUNITY HEALTH CENTER ” Practice Location

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