NPIMap

Organization Active NPI

Canyon Gate Medical Group

  • Family Medicine Physician
  • Pahrump, NV
National Provider Identifier
1134421712
Registry record updated Dec 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
936 Issued in NV
Legal business name
CANYON GATE MEDICAL GROUP
Doing business as
canyon gate medical group
Practice address
330 S Lola LN
Suite# 200
Pahrump, NV 89048-0884
Phone
(954) 656-8855
NPI assigned
Dec 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2010

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

Authorized official

Name
Veronica Colon
Title
Credentialing Coordinator
Phone
(954) 656-8855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 936 NV Primary

Addresses

Primary practice location

330 S Lola LN
Suite# 200
Pahrump, NV 89048-0884

Mailing address

2929 N University Dr
Suite# 110
Coral Springs, FL 33065-5081
Phone (775) 751-0695

Other names 1

  • canyon gate medical group Doing business as

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": "1291248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291248000000",
    "number": "1134421712",
    "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": "775-751-0695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 S LOLA LN",
            "address_2": "SUITE# 200",
            "city": "PAHRUMP",
            "state": "NV",
            "postal_code": "890480884",
            "telephone_number": "954-656-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON GATE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-02",
        "last_updated": "2010-12-02",
        "status": "A",
        "authorized_official_last_name": "COLON",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "954-656-8855"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "canyon gate medical group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pahrump, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.