Organization
BLACK CANYON MEDICAL
Active
Other names
BRADSHAW MOUNTAIN FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY CHARLES HANCOCK D.O. (OWNER)
(623) 742-6428
Entity
Organization
Contact information
Practice address
17301 E SPRING VALLEY RD, STE F, SPRING VALLEY, AZ 86333-4263
(928) 632-4909
(623) 374-5576
Mailing address
46641 N BLACK CANYON HWY, STE 5, NEW RIVER, AZ 85087-6941
(623) 742-6428
(623) 465-1561
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
3297
AZ
Other
Enumeration date
09/24/2007
Last updated
09/24/2007
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