# BANNER HEALTH PHYSICIANS ALASKA LLC

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

## Provider details

- **NPI number:** 1962803908
- **Legal business name:** BANNER MEDICAL GROUP
- **Authorized official:** DENNIS DAHLEN (SR VP FINANCE)
- **Authorized official phone:** (602) 747-4000

## Contact information

- **Practice address:** 1001 NOBLE ST, FAIRBANKS, AK 99701-4948
- **Practice address phone:** (907) 459-3507
- **Practice address fax:** (907) 459-3532
- **Mailing address:** 1441 N 12TH ST, PHOENIX, AZ 85006-2837
- **Mailing address phone:** (602) 747-4000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/09/2014
- **Last updated:** 09/11/2014