BANNER PHYSICIAN SPECIALISTS ARIZONA LLC NPI 1366799355

NPI Information

NPI: 1366799355
Provider Name: BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
601 N NAVAJO
PAGE, AZ
ZIP 86040
Phone: (928) 645-0131
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BANNER PHYSICIAN SPECIALISTS ARIZONA LLC is a multi-specialty clinic center in Page, AZ. BANNER PHYSICIAN SPECIALISTS ARIZONA LLC NPI is 1366799355. The provider is registered as an organization entity type.

The provider's business location address is:

601 N NAVAJO
PAGE, AZ
ZIP 86040
Phone: (928) 645-0131
Fax: (928) 645-3549

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 enumeration date for this NPI number is 8/8/2012 and was last updated on 12/29/2021.

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

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	646505	MEDICAID	ARIZONA

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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