# CANYON MEDICAL CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356834642
- **Authorized official:** JOSHUA ERIC MOTL PA-C, MPAS (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (218) 371-9340

## Contact information

- **Practice address:** 34501 S OLD BLACK CANYON HWY \# 1, BLACK CANYON CITY, AZ 85324
- **Practice address phone:** (623) 374-5070
- **Practice address fax:** (623) 374-5068
- **Mailing address:** 14534 W HIDDEN TERRACE LOOP, LITCHFIELD PARK, AZ 85340-0989

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/11/2018
- **Last updated:** 08/14/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1588081087 | — | AZ |
| 05 | — | 912701 | — | AZ |