03D2019099 CLIA NUMBER - BLACK CANYON COMMUNITY HEALTH CENTER INC

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Laboratory Demographics

CLIA Number: 03D2019099

Facility Name: BLACK CANYON COMMUNITY HEALTH CENTER INC

Facility Address:
19251 E OASIS DR
BLACK CANYON CITY, AZ
ZIP 85324
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Facility Phone Number: 623 374-0200

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1679723217

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	03D2019099
LAB Type	Physician Office
Facility Name	BLACK CANYON COMMUNITY HEALTH CENTER INC
Street	19251 E OASIS DR
City	BLACK CANYON CITY
State	AZ
ZIP	85324
Phone	623 374-0200
CertificateType	4
CertificateEffectiveDate	1/24/2023
CertificateExpirationDate	1/23/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024