Organization
BLACK CANYON COMMUNITY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY CHARLES HANCOCK (CEO)
(623) 374-0200
Entity
Organization
Contact information
Practice address
19251 E OASIS DR, BLACK CANYON CITY, AZ 85324-8878
(623) 374-0200
(623) 374-5576
Mailing address
PO BOX 1958, BLACK CANYON CITY, AZ 85324-1958
(623) 374-0200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3297
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
397607
—
AZ
Enumeration date
09/19/2008
Last updated
07/08/2022
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