03D2326800 CLIA NUMBER - BANNER IMAGING SERVICES LLC

Laboratory Demographics

  • CLIA Code: 03D2326800
  • Facility Name: BANNER IMAGING SERVICES LLC
  • Facility Address: 1800 N CIVIC SQ STE 120
    GOODYEAR, AZ
    ZIP 85395
  • Facility Phone: 480 610-7400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOHAMMED KHAN
  • NPI Number: 1841846920
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 03D2326800
LAB Type Physician Office
Facility Name BANNER IMAGING SERVICES LLC
Street 1800 N CIVIC SQ STE 120
City GOODYEAR
State AZ
ZIP 85395
Phone 480 610-7400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2025
Certificate Expiration Date 7/9/2027
Facility Type Physician Office
Lab Director MOHAMMED KHAN

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