Organization
BLACK CANYON COMMUNITY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY CHARLES HANCOCK DO (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
(623) 374-5576
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
07/08/2022
Last updated
12/16/2022
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