Canyon Park Medical Group, Pllc in Edmond - Primary Care
Canyon Park Medical Group, Pllc - NPI 1063525954
Canyon Park Medical Group, Pllc is a Primary Care in Edmond, Oklahoma. Canyon Park Medical Group, Pllc practices all healthcare services and medical treatments related to Primary Care. The NPI Number for Canyon Park Medical Group, Pllc is 1063525954. The last update date is 2011-05-02.
Canyon Park Medical Group, Pllc's current location address is 1501 E 19th St, Edmond, Oklahoma. You can contact this provider via phone number 4053486611 and fax number 4053489280. The mailing address for Canyon Park Medical Group, Pllc is 1501 E 19th St, Edmond, Oklahoma. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Canyon Park Medical Group, Pllc |
|---|---|
| Address | 1501 E 19th St, Edmond, Oklahoma |
| Phone Number | 4053486611 |
| Fax Number | 4053489280 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | CLINIC MAN |
|---|---|
| Authorized Official Name | Keith Lynn Tonya |
| Telephone Number | 4053486611 |
NPI Number Detail
| NPI Number | 1063525954 |
|---|---|
| Provider Enumeration Date | 2006-08-16 |
| Last Updated Date | 2011-05-02 |
Provider Mailing Address Detail
| Address | 1501 E 19th St |
|---|---|
| City | Edmond |
| State | Oklahoma (OK) |
| Post Code | 730136618 |
| Phone Number | 4053486611 |
| Fax Number | 4053489280 |
Provider's Primary Taxonomy Detail
| Speciality | Primary Care |
|---|---|
| Taxonomy | 261Qp2300X |
| Licence No | 8699 |
|
Definition: Serves as the first point of contact for comprehensive healthcare services. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 37DO469469 | OK | CLIA # | |
| CH5055 | OK | RAILROAD MEDICARE # | |
| 100748060A | OK | -- | |
| 4589400001 | OK | DMERC GROUP # |
Post Comment/ Review Below
What is the unique identifier code issued to Canyon Park Medical Group, Pllc by the Centers for Medicare & Medicaid Services (CMS)?
The Canyon Park Medical Group, Pllc has been assigned the NPI (National Provider Identifier) 1063525954. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Could you share the physical location details of Canyon Park Medical Group, Pllc?
The Canyon Park Medical Group, Pllc is situated at 1501 E 19Th St, in the city of Edmond, state of OK, with the zip code 730136618.
What is the Canyon Park Medical Group, Pllc's area of specialization and corresponding taxonomy classification?
The Canyon Park Medical Group, Pllc's specialty field is Primary Care, and it falls under the taxonomy code 261Qp2300X, which categorizes healthcare providers based on their specialties.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1063525954 to Canyon Park Medical Group, Pllc?
The Centers for Medicare & Medicaid Services originally issued the 1063525954 to Canyon Park Medical Group, Pllc on 2006-08-16.
As of what date were the details pertaining to Canyon Park Medical Group, Pllc last refreshed?
The information related to the Canyon Park Medical Group, Pllc, including its address, specialty, and other relevant details, was last updated on 2011-05-02.