| Black Canyon Community Health Center | |
|
19251 E Oasis Dr Black Canyon City AZ 85324-8878 | |
| (623) 374-0200 | |
| (623) 374-5576 |
| Full Name | Black Canyon Community Health Center |
|---|---|
| Speciality | Family Medicine |
| Location | 19251 E Oasis Dr, Black Canyon City, Arizona |
| Authorized Official Name and Position | Randy Charles Hancock (CEO) |
| Authorized Official Contact | 6233740200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Canyon Community Health Center Po Box 1958 Black Canyon City AZ 85324-1958 Ph: (623) 374-0200 | Black Canyon Community Health Center 19251 E Oasis Dr Black Canyon City AZ 85324-8878 Ph: (623) 374-0200 |
| NPI Number | 1679723217 |
|---|---|
| Provider Enumeration Date | 09/19/2008 |
| Last Update Date | 07/08/2022 |
| Medicare PECOS PAC ID | 6406900331 |
|---|---|
| Medicare Enrollment ID | O20090812000350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679723217 | NPI | - | NPPES |
| 397607 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 3297 (Arizona) | Primary |
| Provider Name | Randy C Hancock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467432971 PECOS PAC ID: 9830098433 Enrollment ID: I20040102000515 |
| Provider Name | Jodi M Palmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578942165 PECOS PAC ID: 0941514277 Enrollment ID: I20150730013707 |
| Provider Name | Randall J Goodfriend |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467646760 PECOS PAC ID: 5496105488 Enrollment ID: I20240103003093 |
| Provider Name | Shannon M Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720854144 PECOS PAC ID: 6103269394 Enrollment ID: I20240205002063 |
Canyon Medical Clinic Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 34501 S Old Black Canyon Hwy # 1, Black Canyon City, AZ 85324 Phone: 623-374-5070 Fax: 623-374-5068 | |
Cherry Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 18850 E. Schoolhouse Road, Black Canyon City, AZ 85324 Phone: 623-374-5215 Fax: 623-374-8969 |