Organization
BLACK CANYON FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA A MCGUFFEY MD (OWNER)
(208) 365-6311
Entity
Organization
Contact information
Practice address
119 N WARDWELL AVE, EMMETT, ID 83617-3040
(208) 365-6311
(208) 365-1003
Mailing address
PO BOX 16820, BOISE, ID 83715-6820
(208) 323-9130
(208) 323-9070
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/06/2007
Last updated
08/22/2020
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