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CANYON PARK MEDICAL GROUP, PLLC
NPI 1063525954
Clinic/Center - Primary Care in Edmond, OK

Active since August 16, 2006
1501 E 19TH ST, EDMOND, OK 73013(405) 348-6611(405) 348-9280 Get Directions Write a Review

NPPES record last updated: May 2, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Canyon Park Medical Group, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CANYON PARK MEDICAL GROUP, PLLC (NPI 1063525954) is a healthcare organization registered as a primary care in Edmond, Oklahoma and active in the NPI registry since August 2006. The organization lists Tonya Lynn Keith, Clinic Manager, as its authorized official.

NPPES Registry Identity

NPI1063525954
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameCANYON PARK MEDICAL GROUP, PLLC
Location Address1501 E 19TH STEdmond, OK 73013-6618
Mailing Address1501 E 19th StEdmond, OK 73013-6618 · (405) 348-6611 · Fax (405) 348-9280
Phone(405) 348-6611
Fax(405) 348-9280
Organization SubpartNo
Authorized OfficialTonya Lynn KeithClinic Manager · (405) 348-6611
Enumeration DateAugust 16, 2006
Last NPPES UpdateMay 2, 2011
✔ NPI 1063525954 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in OK · 8699
1501 E 19TH ST, Edmond, OK 73013
Open in Google Maps ↗

Other Identifiers 6

OtherCH5055OK · Railroad Medicare #
Medicaid100748060AOK
Medicare ID-Type Unspecified400522056OK · Medicare Group #
Other=========001OK · Bcbs Group #
Other4589400001OK · Dmerc Group #
Other37DO469469OK · Clia #

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

OPTIMUM POST ACUTE CARE PLLC
Hospitalist
1501 E 19TH ST
EDMOND, OK 73013
Oklahoma County (405) 367-6180
OPTIMUM CARE HOSPITALIST GROUP PLLC
Internal Medicine
1501 E 19TH ST
EDMOND, OK 73013
Oklahoma County (405) 367-6180
MIDWEST HOSPITALIST GROUP PLLC
Internal Medicine
1501 E 19TH ST
EDMOND, OK 73013
Oklahoma County (405) 367-6180
MRS. VENESSA EMMA PAYNE MSN, APRN, FNP-C
Nurse Practitioner (Family)
1501 E 19TH ST
EDMOND, OK 73013
Oklahoma County (405) 766-8206
OPTIMUM PAC PLLC
Internal Medicine
1501 E 19TH ST
EDMOND, OK 73013
Oklahoma County (405) 367-6180
MUHAMMAD SANAULLAH M.D
Internal Medicine
1501 E 19TH ST
EDMOND, OK 73013
Oklahoma County (405) 471-6511
OPTIMUM PRIMARY CARE PLLC
Internal Medicine
1501 E 19TH ST
EDMOND, OK 73013
Oklahoma County (405) 471-6511
CAITLIN REBECCA ADAY APRN-CNP
Nurse Practitioner (Family)
1501 E 19TH ST
EDMOND, OK 73013
Oklahoma County (405) 348-6611

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Canyon Park Medical Group, PLLC's NPI number?

The NPI number for Canyon Park Medical Group, PLLC is 1063525954. It was assigned to this organization in the NPPES registry on August 16, 2006.

Where is Canyon Park Medical Group, PLLC located?

Canyon Park Medical Group, PLLC is located at 1501 E 19th St, Edmond, OK 73013. The listed phone number is (405) 348-6611.

What is Canyon Park Medical Group, PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Canyon Park Medical Group, PLLC was last updated on May 2, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.