Organization Name: | BANNER PHYSICIAN SPECIALISTS ARIZONA LLC |
NPI Number: | 1316228802 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DENNIS E DAHLEN (SR VP FINANCE) |
Mailing Address: | 37100 N Gantzel Rd Ste 107 San Tan Valley |
State: | AZ US |
Postal Code: | 851407349 |
Phone Number: | 4803944480 |
Fax Number: | |
NPI Enumeration Date: | 08/29/2011 |
NPI Last Update Date: | 08/31/2011 |
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: |