NPIMap

Organization Active NPI

Canyonlands Community Health Care

Doing business as Duncan Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Duncan, AZ
National Provider Identifier
1033275706
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC 4096 Issued in AZ
Legal business name
CANYONLANDS COMMUNITY HEALTH CARE
Doing business as
Duncan Community Health Center
Practice address
227 Main St.
Duncan, AZ 85534
Phone
(928) 359-1380
Fax
(928) 359-1381
NPI assigned
Dec 28, 2006
Last updated
Mar 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CANYONLANDS COMMUNITY HEALTH CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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

Authorized official

Name
Christopher Hansen
Title
Ceo
Phone
(928) 645-9675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC 4096 AZ Primary

Addresses

Primary practice location

227 Main St.
Duncan, AZ 85534

Mailing address

PO Box 1625
Page, AZ 86040-1625
Phone (928) 645-9675

Other identifiers 1

IdentifierTypeStateIssuer
933609MedicaidAZ

Other names 1

  • Duncan Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000713 AZ Part B Supplier - Clinic/Group Practice 4082509591 Receives reassigned benefits from 42 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Safford, AZ; Pima, AZ; Page, AZ; Globe, AZ; Duncan, AZ; Clifton, AZ; Chilchinbito, AZ; Beaver Dam, AZ
O20071127000636 AZ Part A Provider - Federally Qualified Health Center (FQHC) 4082509591 1 other NPI on this enrollment
Practice locations: Duncan, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033275706. Details of each certification follow.

Federally qualified health center certification: CCN 031848

Legal name
CANYONLANDS COMMUNITY HEALTH CARE
Doing business as
CANYONLANDS HEALTHCARE-DUNCAN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 24, 2005
Last certification
Jun 24, 2005
Ownership / control type
For profit – corporation
Most recent change of ownership
Apr 1, 2006 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Feb 6, 1975 in AZ
Enrollment address
227 Main St
Duncan, AZ 85534-9701

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Lake Powell Medical Cen

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Janice Lovett Individual Other Jul 1, 2016
Richard Baker Individual Corporate DirectorBoard Director Dec 16, 2016
Marcie Larson Individual Other May 1, 2019
Judith Brittain Individual Corporate DirectorBoard Member Sep 1, 2023
Holly Smith Individual Corporate Officer Nov 30, 2015
W-2 Managing EmployeeCfo Dec 2, 2015
Justine Holguin Individual Other Aug 1, 2020
William Justice Individual Corporate DirectorBoard of Director Dec 16, 2016
Christopher Hansen Individual Corporate OfficerCeo Jan 1, 2016
Thomas Bradley Individual Corporate DirectorBoard of Director Oct 17, 2009
Tom Maikowski Individual Corporate DirectorBoard of Director Dec 16, 2016
Paulette Leblanc Individual Corporate DirectorBoard of Director Dec 16, 2016

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1033275706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1625",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860401625",
            "telephone_number": "928-645-9675",
            "fax_number": "928-645-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 MAIN ST.",
            "city": "DUNCAN",
            "state": "AZ",
            "postal_code": "85534",
            "telephone_number": "928-359-1380",
            "fax_number": "928-359-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYONLANDS COMMUNITY HEALTH CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CANYONLANDS COMMUNITY HEALTH CARE",
        "enumeration_date": "2006-12-28",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-645-9675"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC 4096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "933609",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duncan Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Duncan Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duncan, AZ

Sources for this page

Verify at the official NPI Registry.