CANYON PEDIATRICS INC NPI 1831185362

NPI Information

NPI: 1831185362
Provider Name: CANYON PEDIATRICS, INC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 03D0956774

Address:
2451 E BASELINE RD
SUITE 200
GILBERT, AZ
ZIP 85234
Phone: (480) 507-2213
Get Directions

CANYON PEDIATRICS, INC is a primary care clinic center in Gilbert, AZ. CANYON PEDIATRICS, INC NPI is 1831185362. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2451 E BASELINE RD
SUITE 200
GILBERT, AZ
ZIP 85234-471
Phone: (480) 507-2213
Fax: (480) 626-6508

The provider's authorized official is Richard Brubaker .
The authorized official title is Ceo and has the following contact phone number (480) 776-7155.

The CLIA number assigned to this NPI record is 03D0956774 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/20/2005 and was last updated on 3/28/2024.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine				No
2	208000000X	Pediatrics				No
3	261Q00000X	Clinic/Center				No
4	261QP2300X	Clinic/Center	Primary Care			Yes
5	302R00000X	Health Maintenance Organization		20136	ARIZONA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	053504	MEDICAID	ARIZONA
2	AZ0889880	OTHER	ARIZONA	BLUE CROSS BLUE SHEILD
3	2048349	OTHER	ARIZONA	AETNA HEALTH CAER
4	183427266	OTHER	ARIZONA	TRICARE
5	6327185	OTHER	ARIZONA	CIGNA US HEALTH CARE
6	1Z5874	OTHER	ARIZONA	HEALTH NET

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

NPI Synchronization or Removal

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