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BLACK CANYON MEDICAL L.L.C. NPI 1164619821


NPI Information

NPI: 1164619821
Provider Name: BLACK CANYON MEDICAL L.L.C.

Doing Business As: MALIN MEDICAL, LLC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 03D1106762

Address:
17301 E SPRING VALLEY RD
MAYER, AZ
ZIP 86333
Phone: (928) 632-4909
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BLACK CANYON MEDICAL L.L.C. is a family medicine in Mayer, AZ. The provider is 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. BLACK CANYON MEDICAL L.L.C. NPI is 1164619821. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Malin Medical, Llc.

The provider's business location address is:

17301 E SPRING VALLEY RD
MAYER, AZ
ZIP 86333-263
Phone: (928) 632-4909
Fax: (928) 632-4973

The provider's authorized official is Kerry D Malin .
The authorized official title is Provider and has the following contact phone number (928) 710-5851.

The CLIA number assigned to this NPI record is 03D1106762 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/26/2007 and was last updated on 3/9/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine3297ARIZONAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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