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BLACK CANYON MEDICAL NPI 1972799856


NPI Information

NPI: 1972799856
Provider Name: BLACK CANYON MEDICAL

Doing Business As: BRADSHAW MOUNTAIN FAMILY MEDICINE

Classification: Allergy & Immunology - 207K00000X
Entity Type: Organization

CLIA Number: 03D2111795

Address:
17301 E SPRING VALLEY RD
STE F
SPRING VALLEY, AZ
ZIP 86333
Phone: (928) 632-4909
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BLACK CANYON MEDICAL is an allergy immunology in Spring Valley, AZ. The provider is an allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. BLACK CANYON MEDICAL NPI is 1972799856. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Bradshaw Mountain Family Medicine.

The provider's business location address is:

17301 E SPRING VALLEY RD
STE F
SPRING VALLEY, AZ
ZIP 86333-263
Phone: (928) 632-4909
Fax: (623) 374-5576

The provider's authorized official is Randy Charles Hancock .
The authorized official title is Owner and has the following contact phone number (623) 742-6428.

The CLIA number assigned to this NPI record is 03D2111795 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/24/2007 and was last updated on 9/24/2007.


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
1207K00000XAllergy & Immunology3297ARIZONAYes

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: 11/14/2023

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