03D2106649 CLIA NUMBER - BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Laboratory Demographics

CLIA Number: 03D2106649

Facility Name: BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Facility Address:
21772 S ELLSWORTH LOOP RD
QUEEN CREEK, AZ
ZIP 85142
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Facility Phone Number: (480) 512-3700

Facility Type: PHYSICIAN OFFICE

Certificate Type: Microscopy

NPI Number: 1629557913

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	03D2106649
LAB Type	PHYSICIAN OFFICE
Facility Name	BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Street	21772 S ELLSWORTH LOOP RD
City	QUEEN CREEK
State	AZ
ZIP	85142
Phone	(480) 512-3700

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This page was last updated on: 5/11/2023