# BANNER CANCER CENTER SPECIALISTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BANNER MEDICAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588158448
- **Legal business name:** BANNER MEDICAL GROUP
- **Authorized official:** SHIVA BIRDI (CEO)
- **Authorized official phone:** (602) 747-4000

## Contact information

- **Practice address:** 807 S PONDEROSA ST, PAYSON, AZ 85541-5542
- **Practice address phone:** (928) 471-3222
- **Practice address fax:** (928) 472-3404
- **Mailing address:** 2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0200X | Oncology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/14/2018
- **Last updated:** 03/06/2025