| Organization Name: | BANNER GOOD SAMARITAN LIVER DISEASE CENTER |
| NPI Number: | 1154639797 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DENNIS E DAHLEN (SR VP FINANCE) |
| Mailing Address: | 117 E Main St Suite A Payson |
| State: | AZ US |
| Postal Code: | 855415293 |
| Phone Number: | 6028394123 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2010 |
| NPI Last Update Date: | 03/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |