| Black Canyon Community Health Center Inc. | |
|
17301 E Spring Valley Rd Ste F Mayer AZ 86333-4263 | |
| (623) 374-0200 | |
| (623) 374-5576 |
| Full Name | Black Canyon Community Health Center Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 17301 E Spring Valley Rd Ste F, Mayer, 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 Inc. Po Box 12 Black Canyon City AZ 85324-0012 Ph: (623) 374-0200 | Black Canyon Community Health Center Inc. 17301 E Spring Valley Rd Ste F Mayer AZ 86333-4263 Ph: (623) 374-0200 |
| NPI Number | 1124730627 |
|---|---|
| Provider Enumeration Date | 12/16/2022 |
| Last Update Date | 12/16/2022 |
| Certification Date | 12/16/2022 |
| Medicare PECOS PAC ID | 6406900331 |
|---|---|
| Medicare Enrollment ID | O20230601002988 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124730627 | NPI | - | NPPES |
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