Organization
BANNER HEALTH
Active
Parent organization
MEDVANTX, INC.
Other names
Good Samaritan Medicine Residency 12th St
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1300 N 12TH ST, SUITE 605, PHOENIX, AZ 85006-2848
(602) 839-2668
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
45424
AZ
Other
Enumeration date
05/15/2014
Last updated
01/31/2022
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