| Black Canyon Medical L.l.c. | |
|
17301 E Spring Valley Rd Mayer AZ 86333-4263 | |
| (928) 632-4909 | |
| (928) 632-4973 |
| Full Name | Black Canyon Medical L.l.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 17301 E Spring Valley Rd, Mayer, Arizona |
| Authorized Official Name and Position | Kerry D Malin (PROVIDER) |
| Authorized Official Contact | 9287105851 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Canyon Medical L.l.c. 17301 E Spring Valley Rd Ste F Mayer AZ 86333-4263 Ph: (928) 710-5851 | Black Canyon Medical L.l.c. 17301 E Spring Valley Rd Mayer AZ 86333-4263 Ph: (928) 632-4909 |
| NPI Number | 1164619821 |
|---|---|
| Provider Enumeration Date | 09/26/2007 |
| Last Update Date | 03/09/2020 |
| Medicare PECOS PAC ID | 8527952167 |
|---|---|
| Medicare Enrollment ID | O20040212000765 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164619821 | NPI | - | NPPES |
| 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 | Linda J Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013291707 PECOS PAC ID: 2668496266 Enrollment ID: I20060123000490 |
| Provider Name | Elizabeth Tarufelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336162866 PECOS PAC ID: 0749285831 Enrollment ID: I20060923000053 |
Malin Medical, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 17301 E Spring Valley Rd Ste F, Mayer, AZ 86333 Phone: 928-632-4909 Fax: 928-632-4973 | |
Carelock, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 20172 E Stagecoach Trl Ste B, Mayer, AZ 86333 Phone: 928-632-4399 |