Black Canyon Medical

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

3297 Issued in AZ

Legal business name

BLACK CANYON MEDICAL

Doing business as

Bradshaw Mountain Family Medicine

Practice address

17301 E Spring Valley Rd
Ste F
Spring Valley, AZ 86333-4263

Phone

(928) 632-4909

Fax

(623) 374-5576

NPI assigned

Sep 24, 2007

Last updated

Sep 24, 2007By 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

Dr. Randy Charles Hancock, D.O.

Title

Owner

Phone

(623) 742-6428

Specialties & licenses 1

Addresses

Other names 1

• BRADSHAW MOUNTAIN FAMILY MEDICINE Doing business as

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190592000000",
    "number": "1972799856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46641 N BLACK CANYON HWY",
            "address_2": "STE 5",
            "city": "NEW RIVER",
            "state": "AZ",
            "postal_code": "850876941",
            "telephone_number": "623-742-6428",
            "fax_number": "623-465-1561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17301 E SPRING VALLEY RD",
            "address_2": "STE F",
            "city": "SPRING VALLEY",
            "state": "AZ",
            "postal_code": "863334263",
            "telephone_number": "928-632-4909",
            "fax_number": "623-374-5576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK CANYON MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2007-09-24",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-742-6428",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "AZ",
            "license": "3297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRADSHAW MOUNTAIN FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sandra D. Coco, M.A., CCC-A
• Douglas Kendall Conley, FNP
• Horizon Dental Group Spring Valley
• Emily Lyford, M.A.
• New Day Rising

• Allergy & Immunology Physician in Spring Valley, AZ
• Providers in Spring Valley, AZ by specialty
• Allergy & Immunology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; 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.