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Organization
BLACK CANYON MEDICAL GROUP PLLC
Active
Organization
BLACK CANYON MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA MCGUFFEY MD (OWNER)
(208) 365-2735
Entity
Organization
Contact information
Practice address
426 HIGHWAY 16, EMMETT, ID 83617-9461
(208) 365-2735
(208) 365-2737
Mailing address
426 HIGHWAY 16, EMMETT, ID 83617-9461
(208) 365-2735
(208) 365-2737
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M9309
ID
Other
Enumeration date
07/12/2017
Last updated
07/21/2022
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