NPIMap

Organization Active NPI

Canyon Gate Medical Group, LLC

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1013249788
Registry record updated Feb 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CANYON GATE MEDICAL GROUP, LLC
Practice address
10155 W Twain Ave
Suite # 110
Las Vegas, NV 89147-6722
Phone
(702) 243-2689
Fax
(702) 243-2632
NPI assigned
Feb 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ricki Moskow
Title
President
Phone
(954) 656-8855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

10155 W Twain Ave
Suite # 110
Las Vegas, NV 89147-6722

Mailing address

2929 N University Dr
Suite # 110
Coral Springs, FL 33065-5081
Phone (954) 656-8855

National Provider Directory

National Provider Directory
Tax ID family
Canyon Gate Medical Group6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265328000000",
    "number": "1013249788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 N UNIVERSITY DR",
            "address_2": "SUITE # 110",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330655081",
            "telephone_number": "954-656-8855",
            "fax_number": "954-656-8856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10155 W TWAIN AVE",
            "address_2": "SUITE # 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891476722",
            "telephone_number": "702-243-2689",
            "fax_number": "702-243-2632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON GATE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-05",
        "last_updated": "2010-02-05",
        "status": "A",
        "authorized_official_last_name": "MOSKOW",
        "authorized_official_first_name": "RICKI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-656-8855"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.