Black Canyon Medical L.L.C.
NPI 1164619821ActiveOrganization· Family Medicine· Mayer, AZ
Family Medicine in Mayer, Arizona, registered in NPPES in September 2007. The authorized official on file is Kerry D. Malin, PA, Provider.
Overview
| NPI | 1164619821 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 26, 2007 |
| Last updated in NPPES | Mar 9, 2020 |
| Certified by provider | Mar 9, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | 3297 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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