# BLACK CANYON MEDICAL L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Malin Medical, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164619821
- **Authorized official:** KERRY D MALIN PA (PROVIDER)
- **Authorized official phone:** (928) 710-5851

## Contact information

- **Practice address:** 17301 E SPRING VALLEY RD, MAYER, AZ 86333-4263
- **Practice address phone:** (928) 632-4909
- **Practice address fax:** (928) 632-4973
- **Mailing address:** 17301 E SPRING VALLEY RD STE F, MAYER, AZ 86333-4263
- **Mailing address phone:** (928) 710-5851
- **Mailing address fax:** (928) 632-4973

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 3297 | AZ | Yes |

## Other

- **Enumeration date:** 09/26/2007
- **Last updated:** 03/09/2020