Organization
BANNER MEDICAL GROUP PEDIATRIC SLEEP, LLC
Active
Parent organization
BANNER MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1828 E FLORENCE BLVD BLDG C STE 136, CASA GRANDE, AZ 85122
(520) 381-6282
(520) 381-6051
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Enumeration date
01/20/2021
Last updated
12/30/2021
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