OrganizationActive
Canyon Park Medical Group, PLLC
NPI 1063525954 · Primary Care Clinic/Center · Edmond, OK
Provider details
- NPI number
- 1063525954
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Tonya Keith, Clinic Manager(405) 348-6611
- License
- 8699 (OK)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1501 E 19th St
Edmond, OK 73013-6618
Phone: (405) 348-6611
Fax: (405) 348-9280
Street-level locationGet directions
Mailing address
1501 E 19th St
Edmond, OK 73013-6618
Registry dates
- Enumerated
- 2006-08-16
- Last updated
- 2011-05-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.