Organization
BANNER ARIZONA MEDICAL CLINIC LTD
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS DAHLEN (SR VICE PRESIDENT - FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
13640 N PLAZA DEL RIO BLVD, PEORIA, AZ 85381-4846
(623) 876-3800
(623) 972-9590
Mailing address
13640 N PLAZA DEL RIO BLVD, PEORIA, AZ 85381-4846
(623) 876-3800
(623) 972-9590
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
OTC3936
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0516437
—
AZ
Enumeration date
04/25/2006
Last updated
12/03/2008
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