Canyonlands Community Health Care
Organization Active NPI Federally Qualified Health Center (FQHC) · Duncan, AZ
NPI 1033275706 · NPPES record last updated Mar 20, 2023
Key facts
- NPI
- 1033275706
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- OTC 4096 (AZ)
- Legal business name
- CANYONLANDS COMMUNITY HEALTH CARE
- Practice address
- 227 Main St.
Duncan, AZ 85534 - Phone
- (928) 359-1380
- Fax
- (928) 359-1381
- NPI assigned
- Dec 28, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- CANYONLANDS COMMUNITY HEALTH CARE
Authorized official
- Name
- Christopher Hansen
- Title
- Ceo
- Phone
- (928) 645-9675
Other NPIs on the same Medicare enrollment 12
Other NPIs with the same Medicare PAC ID 10
Practitioners 30
-
Micah Charles French, FNP-C
-
Michelle L Barker, LCSW
-
Marianne Bennett, FNP-C
-
Sara Kay Bennett, DNP, RNP, FNP
-
Janeen Bjork, MD
-
Michelle Anne Craft, APRN-RNP, FNP-BC
-
Cassidy Lorraine Ducray, APRN
-
Rahsaan Lateef Lindsey, M.D.
-
Jilian McDermott, APRN, PMHNP-BC
-
Anida Pierson, FNP
-
Brian Savery, LPC
-
Joel Swanner, PA
-
Ava Zabihi, LPC
-
Raymon E Darling, MD
-
Chris Hansen, PA-C
-
Philip Hartwell, MD
-
Jeffrey Kiser, APRN
-
Brian Dwayne Lefler, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ
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
- Corporation · Non-profit
- Incorporated
- Feb 6, 1975 in AZ
- Enrollment address
- 227 Main St
Duncan, AZ 85534-9701
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Janice Lovett |
Other | Jul 1, 2016 | |
| Richard Baker |
Corporate Director |
Dec 16, 2016 | |
| Marcie Larson |
Other | May 1, 2019 | |
| Judith Brittain |
Corporate Director |
Sep 1, 2023 | |
| Holly Smith |
Corporate Officer | Nov 30, 2015 | |
| W-2 Managing Employee |
Dec 2, 2015 | ||
| Justine Holguin |
Other | Aug 1, 2020 | |
| William Justice |
Corporate Director |
Dec 16, 2016 | |
| Christopher Hansen |
Corporate Officer |
Jan 1, 2016 | |
| Thomas Bradley |
Corporate Director |
Oct 17, 2009 | |
| Tom Maikowski |
Corporate Director |
Dec 16, 2016 | |
| Paulette Leblanc |
Corporate Director |
Dec 16, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Lake Powell Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | OTC 4096 | AZ | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 933609 | Medicaid | AZ |
Other names
- Duncan Community Health Center
Other providers in Duncan, AZ
- Sarah Rebekah Barker
- Marianne Bennett
- Canyonlands Community Healthcare
- Candice Helen Damron
- Rosalyn Harriett
- Pamela Harrington
All providers in Duncan, AZ · Federally Qualified Health Center (FQHC) in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.