Canyon Medical Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CANYON MEDICAL CLINIC LLC

Practice address

34501 S Old Black Canyon Hwy # 1
Black Canyon City, AZ 85324

Phone

(623) 374-5070

Fax

(623) 374-5068

NPI assigned

Jun 11, 2018

Last updated

Aug 14, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joshua Eric Motl, PA-C, MPASNPI 1588081087

Title

Physician Assistant

Phone

(218) 371-9340

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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.

• Joshua E Motl, PA-C

  • Physician Assistant
  • Cordes Lakes, AZ
  • NPI 1588081087
  Authorized official Same address or phone

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534204800000",
    "number": "1356834642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14534 W HIDDEN TERRACE LOOP",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853400989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34501 S OLD BLACK CANYON HWY # 1",
            "city": "BLACK CANYON CITY",
            "state": "AZ",
            "postal_code": "85324",
            "telephone_number": "623-374-5070",
            "fax_number": "623-374-5068"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34501 S Old Black Canyon Hwy # 3",
            "address_purpose": "LOCATION",
            "city": "Black Canyon City",
            "state": "AZ",
            "postal_code": "853249723",
            "country_code": "US",
            "telephone_number": "218-371-9340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CANYON MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-11",
        "last_updated": "2018-08-14",
        "status": "A",
        "authorized_official_last_name": "MOTL",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "218-371-9340",
        "authorized_official_credential": "PA-C, MPAS"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588081087",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "912701",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Black Canyon Community Health Center, Inc.
• Black Canyon Fire District (Black Canyon Fire Department)
• Black Canyon Physical Therapy, PLLC
• Marci Brown-Gilpin, LCSW
• Canon Elementary School District
• Emd Medical Services LLC (Cherry Family Practice)
• Randy Charles Hancock, DO
• Home Health Services, PLLC (Midstate Physical Therapy)
• Andrea Kay Irving, D.O.
• Paw Kamwee, N.M.D

• Family Medicine Physician in Black Canyon City, AZ
• Providers in Black Canyon City, 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 Aug 14, 2018; 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.