NPIMap

Organization Active NPI

Canyon Gate Medical Group LLC

  • Internal Medicine Physician
  • Coral Springs, FL
National Provider Identifier
1598085797
Registry record updated Jun 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
12804 Issued in NV
Legal business name
CANYON GATE MEDICAL GROUP LLC
Practice address
2929 N. University Dr.
Suite # 110
Coral Springs, FL 33065-5081
Phone
(954) 656-8855
Fax
(954) 656-8855
NPI assigned
Jun 10, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2010

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

Authorized official

Name
Ricki Moskow
Title
President
Phone
(954) 656-8855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 12804 NV Primary

Addresses

Primary practice location

2929 N. University Dr.
Suite # 110
Coral Springs, FL 33065-5081

Mailing address

2832 E. Lake Mead Blvd.
Suite E
N. Las Vegas, NV 89030-6550
Phone (702) 649-5155

Other identifiers 1

IdentifierTypeStateIssuer
1831347731MedicaidNV

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": "1276128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276128000000",
    "number": "1598085797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2832 E. LAKE MEAD BLVD.",
            "address_2": "SUITE E",
            "city": "N. LAS VEGAS",
            "state": "NV",
            "postal_code": "890306550",
            "telephone_number": "702-649-5155",
            "fax_number": "702-649-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 N. UNIVERSITY DR.",
            "address_2": "SUITE # 110",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330655081",
            "telephone_number": "954-656-8855",
            "fax_number": "954-656-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON GATE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-10",
        "last_updated": "2010-06-10",
        "status": "A",
        "authorized_official_last_name": "MOSKOW",
        "authorized_official_first_name": "RICKI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-656-8855"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "12804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831347731",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coral Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.