# BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

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

## Provider details

- **NPI number:** 1992433197
- **Legal business name:** BANNER MEDICAL GROUP
- **Authorized official:** SHIVA BIRDI (CEO/BMG)
- **Authorized official phone:** (602) 747-4000

## Contact information

- **Practice address:** 4375 E IRMA LN, PHOENIX, AZ 85050-4312
- **Practice address phone:** (480) 890-5800
- **Practice address fax:** (480) 890-5920
- **Mailing address:** 2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133NN1002X | Nutrition Education Nutritionist | — | NULL | Yes |
| 133NN1002X | Nutrition Education Nutritionist | — | — | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/15/2022
- **Last updated:** 08/15/2022