Provider Demographics
NPI:1417005026
Name:CANYON MEDICAL SOLUTIONS INC
Entity Type:Organization
Organization Name:CANYON MEDICAL SOLUTIONS INC
Other - Org Name:ADVANCED FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-456-4500
Mailing Address - Street 1:604 W WARNER RD
Mailing Address - Street 2:SUITE B-7
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2906
Mailing Address - Country:US
Mailing Address - Phone:480-456-4500
Mailing Address - Fax:480-456-4503
Practice Address - Street 1:604 W WARNER RD
Practice Address - Street 2:SUITE B-7
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2906
Practice Address - Country:US
Practice Address - Phone:480-456-4500
Practice Address - Fax:480-456-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35679261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ169772Medicaid
AZ169772Medicaid