Provider Demographics
NPI:1689154148
Name:CANYON VIEW MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:CANYON VIEW MEDICAL GROUP LLC
Other - Org Name:PAYSON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-210-2651
Mailing Address - Street 1:15 S 1000 E STE 100
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-5592
Mailing Address - Country:US
Mailing Address - Phone:801-465-9802
Mailing Address - Fax:
Practice Address - Street 1:15 S 1000 E STE 100
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5592
Practice Address - Country:US
Practice Address - Phone:801-465-9802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty