Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Black Canyon Medical Group PLLC

Organization Family Medicine Physician · NPI 1811419708

Black Canyon Medical Group PLLC provides Family Medicine Physician services in Emmett, Idaho. Licensed in Idaho. Registered with an NPI since 2017.

Licensed in
ID
In the registry since
2017
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

426 Highway 16
Emmett, ID 83617-9461
Phone: (208) 365-2735
Fax: (208) 365-2737
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence M9309 (ID)

Record details

NPI number1811419708
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tina McGuffey — Owner · (208) 365-2735
NPI enumeratedJuly 12, 2017
Last updated in NPPESJuly 21, 2022
Mailing address426 Highway 16, Emmett, ID 83617-9461

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