Organization
BANNER HEALTH
Active
Parent organization
MEDVANTX, INC.
Other names
Banner Occupational Health Services
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 520, PHOENIX, AZ 85006-2848
(602) 839-4456
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
19036
AZ
Other
Enumeration date
08/28/2013
Last updated
01/31/2022
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