BANNER CHILDRENS BANNER HEALTH CLINIC LLC NPI 1285278077

NPI Information

NPI: 1285278077
Provider Name: BANNER CHILDRENS BANNER HEALTH CLINIC LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 03D2184217

Address:
117 E MAIN ST STE A100
PAYSON, AZ
ZIP 85541
Phone: (928) 596-4500
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BANNER CHILDRENS BANNER HEALTH CLINIC LLC is a multi-specialty clinic center in Payson, AZ. BANNER CHILDRENS BANNER HEALTH CLINIC LLC NPI is 1285278077. The provider is registered as an organization entity type.

The provider's business location address is:

117 E MAIN ST STE A100
PAYSON, AZ
ZIP 85541-606
Phone: (928) 596-4500

The provider's authorized official is Dennis Laraway .
The authorized official title is Cfo and has the following contact phone number (602) 747-4000.

The CLIA number assigned to this NPI record is 03D2184217 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/5/2019 and was last updated on 12/28/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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