Black Canyon Family Medicine PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLACK CANYON FAMILY MEDICINE PC

Practice address

119 N Wardwell Ave
Emmett, ID 83617-3040

Phone

(208) 365-6311

Fax

(208) 365-1003

NPI assigned

Mar 6, 2007

Last updated

Aug 22, 2020By 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

Tina A McGuffey, MDNPI 1306873435

Title

Owner

Phone

(208) 365-6311

Specialties & licenses 1

Addresses

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.

• Tina A McGuffey, M.D.

  • Family Medicine Physician
  • Emmett, ID
  • NPI 1306873435
  Authorized official Same address or phone

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649300138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16820",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837156820",
            "telephone_number": "208-323-9130",
            "fax_number": "208-323-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 N WARDWELL AVE",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836173040",
            "telephone_number": "208-365-6311",
            "fax_number": "208-365-1003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK CANYON FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCGUFFEY",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-365-6311",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary N Bastian, MD
• Alan Robert Benson, CRNA
• Amber Mechelle Berger, PMHNP-BC
• Malerie Erin Bettfreund, LMSW
• Black Canyon Dental P C
• Black Canyon Medical Group PLLC
• Reece Arthur Bodam
• Kahn Borge, LMSW
• Andrea Bowhay
• Latisha Bowman, LPC

• Family Medicine Physician in Emmett, ID
• Providers in Emmett, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.