03D2117601 CLIA NUMBER - BANNER - UNIVERSITY SUPER SPECIALISTS LLC

Laboratory Demographics

CLIA Number: 03D2117601

Facility Name: BANNER - UNIVERSITY SUPER SPECIALISTS LLC

Facility Address:
1441 N 12TH ST, 2ND FLOOR
PHOENIX, AZ
ZIP 85006
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Facility Phone Number: (602) 521-2900

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1205041126

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	03D2117601
LAB Type	PHYSICIAN OFFICE
Facility Name	BANNER - UNIVERSITY SUPER SPECIALISTS LLC
Street	1441 N 12TH ST, 2ND FLOOR
City	PHOENIX
State	AZ
ZIP	85006
Phone	(602) 521-2900

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