Organization
BANNER HEALTH
Active
Parent organization
MEDVANTX, INC.
Other names
Banner Health Center Peoria
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
13640 N PLAZA DEL RIO BLVD, 3RD FLOOR, SUITE 350, PEORIA, AZ 85381-4846
(623) 583-5044
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
16098
AZ
Other
Enumeration date
05/14/2014
Last updated
01/31/2022
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