Organization
BANNER CHILDRENS BANNER HEALTH CLINIC LLC
Active
Parent organization
BANNER MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP
Authorized official
DR. SHIVA BIRDI (CEO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
(602) 747-4000
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/10/2012
Last updated
09/13/2024
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