Provider Demographics
NPI:1801386677
Name:CANYON FAMILY HEALTH INC
Entity Type:Organization
Organization Name:CANYON FAMILY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:503-767-3226
Mailing Address - Street 1:1095 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1203
Mailing Address - Country:US
Mailing Address - Phone:503-767-3226
Mailing Address - Fax:503-767-3227
Practice Address - Street 1:1095 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1203
Practice Address - Country:US
Practice Address - Phone:503-767-3226
Practice Address - Fax:503-767-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty