03D1069425 CLIA NUMBER - BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Laboratory Demographics

CLIA Number: 03D1069425

Facility Name: BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Facility Address:
9305 W THOMAS RD, STE 380
PHOENIX, AZ
ZIP 85037
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Facility Phone Number: 623 327-4144

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1801160569

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	03D1069425
LAB Type	Physician Office
Facility Name	BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Street	9305 W THOMAS RD, STE 380
City	PHOENIX
State	AZ
ZIP	85037
Phone	623 327-4144
CertificateType	4
CertificateEffectiveDate	6/5/2023
CertificateExpirationDate	6/4/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024