# BLACK CANYON COMMUNITY HEALTH CENTER, INC.

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

## Provider details

- **NPI number:** 1679723217
- **Authorized official:** RANDY CHARLES HANCOCK (CEO)
- **Authorized official phone:** (623) 374-0200

## Contact information

- **Practice address:** 19251 E OASIS DR, BLACK CANYON CITY, AZ 85324-8878
- **Practice address phone:** (623) 374-0200
- **Practice address fax:** (623) 374-5576
- **Mailing address:** 19251 E OASIS DR, BLACK CANYON CITY, AZ 85324-8878
- **Mailing address phone:** (623) 374-0200

## Taxonomy

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

## Other

- **Enumeration date:** 09/19/2008
- **Last updated:** 09/23/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 397607 | — | AZ |