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BLACK CANYON COMMUNITY HEALTH CENTER, INC.
NPI 1124730627
Clinic/Center - Federally Qualified Health Center (FQHC) in Mayer, AZ

Active since December 16, 2022CLIA 03D2019099 · Waiver
17301 E SPRING VALLEY RD STE F, MAYER, AZ 86333(623) 374-0200(623) 374-5576 Get Directions Write a Review

NPPES record last updated: June 18, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Black Canyon Community Health Center, Inc. NPPES

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

BLACK CANYON COMMUNITY HEALTH CENTER, INC. (NPI 1124730627) is a healthcare organization registered as a federally qualified health center (fqhc) in Mayer, Arizona and active in the NPI registry since December 2022. The organization holds a CLIA Waiver certificate valid through January 23, 2027 and lists Randy Charles Hancock, Ceo, as its authorized official.

NPPES Registry Identity

NPI1124730627
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameBLACK CANYON COMMUNITY HEALTH CENTER, INC.
Location Address17301 E SPRING VALLEY RD STE FMayer, AZ 86333-4263
Mailing AddressPo Box 12Black Canyon City, AZ 85324-0012 · (623) 374-0200 · Fax (623) 374-5576
Phone(623) 374-0200
Fax(623) 374-5576
Organization SubpartNo
Authorized OfficialRandy Charles HancockCeo · (623) 374-0200
Enumeration DateDecember 16, 2022
Last NPPES UpdateJune 18, 2026
NPPES CertifiedJune 18, 2026
✔ NPI 1124730627 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedFamily MedicineTaxonomy 207Q00000X
17301 E SPRING VALLEY RD STE F, Mayer, AZ 86333
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Blue Cross Blue Shield of Arizona, UnitedHealthcare.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D2019099

Black Canyon Community Health Center Inc · Black Canyon City, AZ
Active · expires Jan 23, 2027
CLIA Number03D2019099
Laboratory TypePhysician Office
Certificate Effective DateJanuary 24, 2025
Certificate Expiration DateJanuary 23, 2027
Laboratory DirectorRandy Hancock
Laboratory Phone(623) 374-0200
Laboratory LocationBlack Canyon Community Health Center Inc19251 E Oasis Dr, Black Canyon City, AZ 85324
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

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

ELIZABETH MARIE TARUFELLI NURSE PRACTITIONER
Nurse Practitioner (Family)
17301 E SPRING VALLEY RD STE F
MAYER, AZ 86333
Yavapai County (928) 632-4909
MR. DOUGLAS KENDALL CONLEY FNP
Nurse Practitioner (Family)
17301 E SPRING VALLEY RD STE F
SPRING VALLEY, AZ 86333
Yavapai County (928) 632-4909
KIMBERLY ANN WHITEHILL FNP
Nurse Practitioner (Family)
17301 E SPRING VALLEY RD STE F
SPRING VALLEY, AZ 86333
Yavapai County (928) 632-4909
MRS. EMILY CATHERINE NORMAN NP
Nurse Practitioner (Adult Health)
17301 E SPRING VALLEY RD STE F
SPRING VALLEY, AZ 86333
Yavapai County (928) 632-4909
ANDREW R BARRIOS PA-C
Physician Assistant
17301 E SPRING VALLEY RD STE F
MAYER, AZ 86333
Yavapai County (928) 404-8004

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 Black Canyon Community Health Center, Inc.'s NPI number?

The NPI number for Black Canyon Community Health Center, Inc. is 1124730627. It was assigned to this organization in the NPPES registry on December 16, 2022.

Where is Black Canyon Community Health Center, Inc. located?

Black Canyon Community Health Center, Inc. is located at 17301 E Spring Valley Rd Ste F, Mayer, AZ 86333. The listed phone number is (623) 374-0200.

What is Black Canyon Community Health Center, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Black Canyon Community Health Center, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2019099) is associated with this NPI, valid through January 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Black Canyon Community Health Center, Inc. accept?

Health plans from Ambetter from Arizona Complete Health, Blue Cross Blue Shield of Arizona and UnitedHealthcare list Black Canyon Community Health Center, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Black Canyon Community Health Center, Inc. was last updated on June 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.