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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
CertificateType 3
CertificateEffectiveDate 12/22/2023
CertificateExpirationDate 12/21/2025
FacilityType PPMP

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