Grand Canyon University

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OTC9096 Issued in AZ

Legal business name

GRAND CANYON UNIVERSITY

Practice address

3300 W Camelback Rd
Health Center
Phoenix, AZ 85017-1097

Phone

(602) 639-6215

Fax

(602) 639-7830

NPI assigned

Sep 6, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Constance Colbert, FNP-BC

Title

Director

Phone

(602) 639-7757

Specialties & licenses 1

Addresses

Other names 1

• Grand Canyon Education, Inc Former legal business name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather A Healy, NP

  • Family Nurse Practitioner
  • Phoenix, AZ
  • NPI 1669493771
  Medicare reassignment NPD
• Lily Anna Limon, FNP-C

  • Family Nurse Practitioner
  • Peoria, AZ
  • NPI 1841761434
  Medicare reassignment NPD
• Matthew D Shores, MD

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1861513889
  Medicare reassignment NPD
• Bethany Whitson, FNP-C

  • Family Nurse Practitioner
  • Phoenix, AZ
  • NPI 1477052876
  Medicare reassignment NPD
• Ashley Nicole Abell, MSN, RN, FNP-C

  • Nurse Practitioner
  • Scottsdale, AZ
  • NPI 1679041099
  NPD (past)
• Penny Laine Lee, FNP-C

  • Family Nurse Practitioner
  • Phoenix, AZ
  • NPI 1477894293
  NPD (past)
• Margaret Eileen Van Liew, NP

  • Family Nurse Practitioner
  • Glendale, AZ
  • NPI 1437709573
  NPD (past)

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

{
    "created_epoch": "1536192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612569600000",
    "number": "1124501069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 W CAMELBACK RD",
            "address_2": "HEALTH CENTER",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850171097",
            "telephone_number": "602-639-6215",
            "fax_number": "602-639-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 W CAMELBACK RD",
            "address_2": "HEALTH CENTER",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850171097",
            "telephone_number": "602-639-6215",
            "fax_number": "602-639-7830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND CANYON UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-06",
        "last_updated": "2021-02-06",
        "certification_date": "2021-02-06",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "602-639-7757",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "OTC9096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Canyon Education, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Grand Canyon Dental, PLLC
• Grand Canyon Education, Inc.
• Grand Canyon Home Care Inc.
• Grand Canyon Home Health Care, Inc.
• Grand Canyon Lab LLC
• Grand Canyon Wellness Center
• Grand Desert Home Health, LLC
• Grand Services and More LLC
• Grand Therapy LTD
• Grande Integrated Wellness Solutions LLC

• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.