| Black Canyon Medical Group Pllc | |
|
426 Highway 16 Emmett ID 83617-9461 | |
| (208) 365-2735 | |
| (208) 365-2737 |
| Full Name | Black Canyon Medical Group Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 426 Highway 16, Emmett, Idaho |
| Authorized Official Name and Position | Tina Mcguffey (OWNER) |
| Authorized Official Contact | 2083652735 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Canyon Medical Group Pllc 426 Highway 16 Emmett ID 83617-9461 Ph: (208) 365-2735 | Black Canyon Medical Group Pllc 426 Highway 16 Emmett ID 83617-9461 Ph: (208) 365-2735 |
| NPI Number | 1811419708 |
|---|---|
| Provider Enumeration Date | 07/12/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 8123393071 |
|---|---|
| Medicare Enrollment ID | O20171003007502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811419708 | NPI | - | NPPES |
| 1346654589 | Medicaid | ID | |
| 1306873435 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M9309 (Idaho) | Primary |
| Provider Name | Elmer G Dodge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508918236 PECOS PAC ID: 4385684299 Enrollment ID: I20050517000711 |
| Provider Name | Tina A Mcguffey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306873435 PECOS PAC ID: 4486549383 Enrollment ID: I20050802000904 |
| Provider Name | Jonathan Barrus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346654589 PECOS PAC ID: 8628295839 Enrollment ID: I20160906002281 |
| Provider Name | Darcy R Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629699251 PECOS PAC ID: 5597186932 Enrollment ID: I20200610002802 |
| Provider Name | Samantha D Blackburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811534613 PECOS PAC ID: 9234536855 Enrollment ID: I20210924001101 |
Emmett Family Services Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2031 E Quail Run Rd, Emmett, ID 83617 Phone: 208-365-2525 Fax: 208-365-2234 | |
Valor Health Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 119 N Wardwell Ave, Emmett, ID 83617 Phone: 208-365-6311 Fax: 208-365-1003 | |
The Smith Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 119 N Wardwell Ave, Emmett, ID 83617 Phone: 208-365-6311 | |
Gem Family Practice, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1108 S Washington Ave, Emmett, ID 83617 Phone: 208-365-3455 Fax: 208-365-3422 | |
Valor Health Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 119 N Wardwell Ave, Emmett, ID 83617 Phone: 208-365-6311 | |
Idaho Behavioral Health Emmett Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 315 S Johns Ave, Emmett, ID 83617 Phone: 208-343-2737 Fax: 208-342-3238 | |
Emmett Family Medicine And Direct Primary Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2001 E Quail Run Rd, Emmett, ID 83617 Phone: 208-365-7131 Fax: 208-365-4464 |