CANYON PARK MEDICAL GROUP, PLLC (NPI# 1063525954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063525954 |
| Entity Type | Organization |
| Organization Name | CANYON PARK MEDICAL GROUP, PLLC |
| Practice Address |
1501 E 19th St Edmond OK 73013-6618 |
| Practice Telephone | 4053486611 |
| Practice Fax Number | 4053489280 |
| Mailing Telephone | 4053486611 |
| Mailing Fax Number | 4053489280 |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2011-05-02 |
| Authorized Official Name | TONYA LYNN KEITH (CLINIC MANAGER) |
| Authorized Official Telephone | 4053486611 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
8699 | OK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100748060A | 05 | |
| OK | DMERC GROUP # | 4589400001 | 01 |
| OK | CLIA # | 37DO469469 | 01 |
| OK | RAILROAD MEDICARE # | CH5055 | 01 |
| Street Address |
1501 E 19TH ST |
| City | EDMOND |
| State | OK |
| Zip Code | 73013-6618 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356318919 | Ronal D Legako | Family Medicine | 1501 E 19th St, Edmond, OK 73013-6618 | 2006-03-02 |
| 1811424732 | Caitlin Rebecca Aday | Nurse Practitioner | 1501 E 19th St, Edmond, OK 73013-6618 | 2017-05-23 |
| 1801152368 | Elizabeth M Nelson | Family Medicine | 1501 E 19th St, Edmond, OK 73013 | 2012-04-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461866 | Alison Church-pugh | Case Manager/Care Coordinator | 1441 Kelley Pointe Pkwy, Edmond, OK 73013 | 2020-09-12 |
| 1699395343 | Dental Specialists of Edmond | Dentist | 16430 Muirfield Pl, Edmond, OK 73013 | 2020-04-23 |
| 1104477215 | Kammerer Richey LLC | Nurse Practitioner | 902 Nw 139th Street Parway, Edmond, OK 73013 | 2019-09-20 |
| 1811459191 | Peak Movement Centre, Pllc | Clinic/Center | 13816 Santa Fe Crossing Dr, Edmond, OK 73013 | 2019-04-04 |
| 1851858492 | Luma Hilal | Pharmacist | 2228 Nw 15th Terrace, Edmond, OK 73013 | 2019-03-01 |
| 1578031571 | Oklahoma Wellness Group LLC | Internal Medicine | 14101 North Esatern Avenue Suite B, Edmond, OK 73013 | 2018-11-07 |
| 1477034395 | Specialty Care Pediatrics, Inc. | Home Health | 2256 Nw 164th Street, Edmond, OK 73013 | 2018-08-28 |
| 1972083921 | Pooja Bhakta | Physician Assistant | Stanbro Healthcare Group LLC, 2000 E. 15th St., Suite 400-a, Edmond, OK 73013 | 2018-08-20 |
| 1417460577 | Oklahoma Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 15103 N Macarthur Blvd, Oklahoma City, OK 73013 | 2017-11-13 |
| 1356879753 | Shawn Smith Optimal Pt and Performance, Pllc | Physical Therapist | 336 Ne 145th Pl, Edmond, OK 73013 | 2017-05-30 |
| Find all providers in zip 73013 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205490984 | Thehealthworxllc | Clinic/Center | 1425 S Santa Fe Ave Ste G, Edmond, OK 73003-5910 | 2019-04-27 |
| 1457821548 | James Mcginn LLC | Clinic/Center | 849 E 33rd St Ste 201b, Edmond, OK 73013-5407 | 2018-11-30 |
| 1235612235 | Balance Medical, Inc. | Clinic/Center | 1019 Waterwood Pkwy Ste E-14, Edmond, OK 73034-5332 | 2018-09-14 |
| 1003227414 | Deer Creek Family Healthcare and Wellness Clinic LLC | Clinic/Center | 19401 N. Portland, Edmond, OK 73012 | 2014-05-20 |
| 1699012435 | Optima Weight & Wellness, LLC | Clinic/Center | 1489 E 15th St, Suite 108, Edmond, OK 73013-5054 | 2013-01-14 |
| 1396909446 | Bryant Street Family Medicine, P.C. | Clinic/Center | 305 South Bryant Ave, 110, Edmond, OK 73034 | 2008-07-17 |
| 1194741249 | Geoffrey W Hoover Md Pllc | Clinic/Center | 122 N Bryant Ave Ste 1, Edmond, OK 73034-6349 | 2006-07-14 |
| 1699391797 | Pollard Family Health and Wellness, LLC | Clinic/Center | 1404 Nw 186th St, Edmond, OK 73012-6202 | 2020-06-24 |
| 1922552348 | Careatc - City of Edmond | Clinic/Center | 28 E Main St, Suite 100, Edmond, OK 73034-4502 | 2016-08-15 |
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|---|---|---|---|---|
| 1609476654 | Team Clinic Management Partners LLC | Clinic/Center | 372 N Cobb, Caney, OK 74533 | 2020-10-29 |
| 1184222705 | Essential Md, Pllc | Clinic/Center | 6316 E 102nd St Ste 100, Tulsa, OK 74137-7061 | 2020-10-15 |
| 1881292191 | Team Clinic Management Partners LLC | Clinic/Center | 3100 W New Orleans St, Broken Arrow, OK 74011-1468 | 2020-10-09 |
| 1972115392 | Team Clinic Management Partners LLC | Clinic/Center | 225 E Omaha St, Broken Arrow, OK 74012-1761 | 2020-08-18 |
| 1093327413 | Team Clinic Management Partners LLC | Clinic/Center | 301 W New Orleans St, Broken Arrow, OK 74011-2206 | 2020-08-18 |
| 1962013110 | Team Clinic Management Partners LLC | Clinic/Center | 4300 E Gary Street, Broken Arrow, OK 74014 | 2020-08-12 |
| 1750992038 | Team Clinic Management Partners LLC | Clinic/Center | 251 E Omaha St, Broken Arrow, OK 74012-1761 | 2020-08-11 |
| 1689285975 | Team Clinic Management Partners LLC | Clinic/Center | 301 E Tucson St, Broken Arrow, OK 74011-7235 | 2020-08-11 |
| 1417568700 | Team Clinic Management Partners LLC | Clinic/Center | 1351 E Albany St, Broken Arrow, OK 74012-8995 | 2020-08-11 |
| 1164033569 | Team Clinic Management Partners LLC | Clinic/Center | 6800 E Quincy Pl, Broken Arrow, OK 74014-4523 | 2020-08-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.