Provider Demographics
NPI:1578645602
Name:CANYON VIEW MEDICAL CENTER,LTD
Entity Type:Organization
Organization Name:CANYON VIEW MEDICAL CENTER,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-645-8823
Mailing Address - Street 1:PO BOX 7050
Mailing Address - Street 2:601 N. NAVAJO DR.
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-7050
Mailing Address - Country:US
Mailing Address - Phone:928-645-8823
Mailing Address - Fax:928-645-2524
Practice Address - Street 1:601 N NAVAJO DR
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-7050
Practice Address - Country:US
Practice Address - Phone:928-645-8823
Practice Address - Fax:928-645-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty