03D2221452 CLIA NUMBER - BANNER IMAGING SERVICES LLC

Laboratory Demographics

  • CLIA Code: 03D2221452
  • Facility Name: BANNER IMAGING SERVICES LLC
  • Facility Address: 7701 W ASPERA BLVD STE 101
    GLENDALE, AZ
    ZIP 85308
  • Facility Phone: 623 248-2050
  • Facility Type: Other - IMAGING CENTER
  • Facility Type: Waiver
  • Lab Director: KHAN MOHAMMED
  • NPI Number: 1770139958
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 03D2221452
LAB Type Other - IMAGING CENTER
Facility Name BANNER IMAGING SERVICES LLC
Street 7701 W ASPERA BLVD STE 101
City GLENDALE
State AZ
ZIP 85308
Phone 623 248-2050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2025
Certificate Expiration Date 4/20/2027
Facility Type Other - IMAGING CENTER
Lab Director KHAN MOHAMMED

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This page was last updated on: 9/29/2025