NPIMap

Organization Active NPI

Canyon Gate Medical Group, LLC

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1649414244
Registry record updated Apr 27, 2009
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
3960 W. Craig Road
Suite # 102
Las Vegas, NV 89031
Phone
(702) 473-8380
Fax
(702) 473-8383
NPI assigned
Apr 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2009

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

3960 W. Craig Road
Suite # 102
Las Vegas, NV 89031

Mailing address

2929 N University Dr
Suite # 110
Coral Springs, FL 33065-5081
Phone (954) 656-8855

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.

Locations

2929 N University Dr
Ste 110
Coral Springs, FL 33065
Phone (954) 637-3270

3960 W Craig Rd
Ste 102
North Las Vegas, NV 89032
Phone (702) 473-8380

NPI Registry JSON

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

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240790400000",
    "number": "1649414244",
    "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": "954-656-8855",
            "fax_number": "954-656-8856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 W. CRAIG ROAD",
            "address_2": "SUITE # 102",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89031",
            "telephone_number": "702-473-8380",
            "fax_number": "702-473-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON GATE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-27",
        "last_updated": "2009-04-27",
        "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; 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.