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Organization
BANNER HEALTH CLINIC
Active
Organization
BANNER HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
8510 W DEER VALLEY RD STE 100, PEORIA, AZ 85382-5386
(623) 561-4532
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
AP9647
AZ
Other
Enumeration date
01/09/2017
Last updated
12/27/2021
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