Organization
BANNER GOOD SAMARITAN LIVER DISEASE CENTER
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS E DAHLEN (SR VP FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
117 E MAIN ST, SUITE A, PAYSON, AZ 85541-5293
(602) 839-4123
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/16/2010
Last updated
03/03/2015
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