03D2181638 CLIA NUMBER - BANNER IMAGING SERVICES LLC

Laboratory Demographics

CLIA Number: 03D2181638

Facility Name: BANNER IMAGING SERVICES LLC

Facility Address:
1828 E FLORENCE BLVD B STE 118
CASA GRANDE, AZ
ZIP 85122
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Facility Phone Number: 520 381-9729

Facility Type: Other - RADIOLOGY CENTER

Certificate Type: Waiver

NPI Number: 1841846920

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	03D2181638
LAB Type	Other - RADIOLOGY CENTER
Facility Name	BANNER IMAGING SERVICES LLC
Street	1828 E FLORENCE BLVD B STE 118
City	CASA GRANDE
State	AZ
ZIP	85122
Phone	520 381-9729
CertificateType	4
CertificateEffectiveDate	4/8/2024
CertificateExpirationDate	4/7/2026
FacilityType	Waiver

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