BLACK CANYON MEDICAL (NPI# 1972799856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972799856 |
| Entity Type | Organization |
| Organization Name | BLACK CANYON MEDICAL |
| Other Organization Name | BRADSHAW MOUNTAIN FAMILY MEDICINE |
| Practice Address |
17301 E Spring Valley Rd Ste F Spring Valley AZ 86333-4263 |
| Mailing Address |
46641 N Black Canyon Hwy Ste 5 New River AZ 85087-6941 |
| Practice Telephone | 9286324909 |
| Practice Fax Number | 6233745576 |
| Mailing Telephone | 6237426428 |
| Mailing Fax Number | 6234651561 |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2007-09-24 |
| Authorized Official Name | DR. RANDY CHARLES HANCOCK (OWNER) |
| Authorized Official Telephone | 6237426428 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207K00000X | Allergy & Immunology | 3297 | AZ | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| BRADSHAW MOUNTAIN FAMILY MEDICINE | Doing Business As Name - Organization |
| Street Address |
17301 E SPRING VALLEY RD STE F |
| City | SPRING VALLEY |
| State | AZ |
| Zip Code | 86333-4263 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003382458 | Best Care Behavioral Homes LLC | Community/Behavioral Health | 13190 Central Ave, Mayer, AZ 86333 | 2018-10-23 |
| 1699091710 | Spring Ridge Academy | Psychiatric Residential Treatment Facility | 13690 S. Burton Rd., Spring Valley, AZ 86333 | 2010-04-14 |
| 1083930283 | Zena Anne Kimbrell | Day Training/Habilitation Specialist | 13522 Main Street, Mayer, AZ 86333 | 2010-04-13 |
| 1720225279 | Jim Nester Loukola | Specialist | 20216 E. Conestogao Dr., Mayer, AZ 86333 | 2009-01-20 |
| 1629297072 | Regina Shawn Kenyon Carlson | Occupational Therapy Assistant | 15452 Cholla Cir, Mayer, AZ 86333 | 2007-04-24 |
| 1558589234 | Sandra Lee Mattson Ebeltoft | Psychologist | 12606 E. Main St., Mayer, AZ 86333 | 2007-04-20 |
| 1083774558 | Kim Machelle Remington | Specialist | 13251 Main Street, Mayer, AZ 86333 | 2006-12-12 |
| 1164582250 | Antoinette Josephine Leggitt | Specialist | 17441 Trail End Road, Mayer, AZ 86333 | 2006-12-11 |
| 1588081087 | Joshua E Motl | Physician Assistant | 20172 E Stagecoach Trl, Cordes Lakes, AZ 86333 | 2014-03-21 |
| 1558617506 | Emily Catherine Norman | Nurse Practitioner | 17301 E Spring Valley Rd Ste F, Spring Valley, AZ 86333 | 2012-07-27 |
| Find all providers in zip 86333 | ||||
| Taxonomy Code | 207K00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007, www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Allergy and Immunology, 2007. http://www.abai.org/ No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083111603 | Arizona Allergy and Asthma Specialists PC | Allergy & Immunology | 16611 S 40th St Ste 170, Phoenix, AZ 85048-0565 | 2018-04-10 |
| 1588192397 | North Scottsdale Allergy Associates | Allergy & Immunology | 6892 E Ironwood Dr, Scottsdale, AZ 85266-7444 | 2017-05-24 |
| 1164756904 | Gregory Michael Cowan | Allergy & Immunology | 9145 W Thunderbird Rd Ste 101, Peoria, AZ 85381-4820 | 2009-09-27 |
| 1740445782 | Stanley Carl Ushinski | Allergy & Immunology | 5160 North Camino Sumo, Tucson, AZ 85718-6044 | 2008-07-18 |
| 1053586917 | Arizona Physicians Pllc | Allergy & Immunology | 5116 W Fawn Dr, Laveen, AZ 85339-2897 | 2008-04-22 |
| 1740466549 | Jeffrey Dale Leitner | Allergy & Immunology | 11209 N Tatum Blvd Ste 175, Stonecreek Medical Associates, Phoenix, AZ 85028-6016 | 2008-01-11 |
| 1124240510 | San Tan Allergy and Asthma PC | Allergy & Immunology | 4915 E Baseline Rd Ste 112, Gilbert, AZ 85234 | 2007-05-03 |
| 1972695914 | Jeffrey M Lime | Allergy & Immunology | 5605 W Eugie, 200, Glendale, AZ 85304-1200 | 2006-09-28 |
| 1053412064 | Allergy Asthma Associates PC | Allergy & Immunology | 2320 N Wyatt Dr Ste 71, Tucson, AZ 85712-2151 | 2006-09-25 |
| 1043314065 | Nabeeh Naufal Lahood | Allergy & Immunology | 2320 N Wyatt Dr, Suite 71, Tucson, AZ 85712-2151 | 2006-09-11 |
| Find all providers with the same taxonomy | ||||
| City | SPRING VALLEY |
| Zip Code | 86333 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.