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CANYON MEDICAL GROUP
NPI 1730764614
Pediatrics in Logan, UT

Active since March 12, 2021CLIA 46D0969712 · Waiver
1325 N 600 E STE 101, LOGAN, UT 84341(435) 750-5599(435) 750-0861 Get Directions Write a Review

NPPES record last updated: March 12, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Canyon Medical Group NPPES

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

CANYON MEDICAL GROUP (NPI 1730764614) is a healthcare organization registered as a pediatrics in Logan, Utah and active in the NPI registry since March 2021. The organization holds a CLIA Waiver certificate valid through January 23, 2028 and lists Wendy C Wimmer, Manager, as its authorized official.

NPPES Registry Identity

NPI1730764614
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameCANYON MEDICAL GROUP
Location Address1325 N 600 E STE 101Logan, UT 84341-6743
Mailing Address1325 N 600 E Ste 101Logan, UT 84341-6743 · (435) 750-5599 · Fax (435) 750-0861
Phone(435) 750-5599
Fax(435) 750-0861
Organization SubpartNo
Authorized OfficialWendy C WimmerManager · (435) 757-2009
Enumeration DateMarch 12, 2021
NPPES CertifiedMarch 12, 2021
✔ NPI 1730764614 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
1325 N 600 E STE 101, Logan, UT 84341
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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

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 46D0969712

Canyon Medical Group · Logan, UT
Active · expires Jan 23, 2028
CLIA Number46D0969712
Laboratory TypePhysician Office
Certificate Effective DateJanuary 24, 2026
Certificate Expiration DateJanuary 23, 2028
Laboratory DirectorRyan R. Bell
Laboratory Phone(435) 750-5599
Laboratory LocationCanyon Medical Group1624 N 200 E Ste 160, Logan, UT 84341
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 3

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

SARAH HOPE HORTON FNP
Nurse Practitioner (Family)
1325 N 600 E STE 101
LOGAN, UT 84341
Cache County (435) 213-3970
RUSSEL T MCKENNA DO
Pediatrics
1325 N 600 E STE 101
LOGAN, UT 84341
Cache County (435) 750-5599
TREEHOUSE ACORN PEDIATRICS & FAMILY CARE
Pediatrics
1325 N 600 E STE 101
LOGAN, UT 84341
Cache County (435) 213-3970

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 Medical Group's NPI number?

The NPI number for Canyon Medical Group is 1730764614. It was assigned to this organization in the NPPES registry on March 12, 2021.

Where is Canyon Medical Group located?

Canyon Medical Group is located at 1325 N 600 E Ste 101, Logan, UT 84341. The listed phone number is (435) 750-5599.

What is Canyon Medical Group's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Canyon Medical Group hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 46D0969712) is associated with this NPI, valid through January 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Canyon Medical Group was last updated on March 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.