Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Black Canyon Medical Group PLLC

Organization Family Medicine Physician · NPI 1811419708

Black Canyon Medical Group PLLC is a Family Medicine Physician 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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