Organization
BANNER HEALTH
Active
Parent organization
MEDVANTX, INC.
Other names
Banner Health Clinic-32nd St Internal Medicine
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
4400 N 32ND ST, SUITE 140, PHOENIX, AZ 85018-3953
(602) 553-4848
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
20737
AZ
Other
Enumeration date
10/22/2013
Last updated
01/31/2022
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