Organization
BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1450 S DOBSON RD STE B221, MESA, AZ 85202-4745
(480) 827-5370
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
07/11/2019
Last updated
12/28/2021
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