# BLACK CANYON MEDICAL

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** BRADSHAW MOUNTAIN FAMILY MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972799856
- **Authorized official:** DR. RANDY CHARLES HANCOCK D.O. (OWNER)
- **Authorized official phone:** (623) 742-6428

## Contact information

- **Practice address:** 17301 E SPRING VALLEY RD, STE F, SPRING VALLEY, AZ 86333-4263
- **Practice address phone:** (928) 632-4909
- **Practice address fax:** (623) 374-5576
- **Mailing address:** 46641 N BLACK CANYON HWY, STE 5, NEW RIVER, AZ 85087-6941
- **Mailing address phone:** (623) 742-6428
- **Mailing address fax:** (623) 465-1561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | 3297 | AZ | Yes |

## Other

- **Enumeration date:** 09/24/2007
- **Last updated:** 09/24/2007