Organization
BANNER MESA MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS E DAHLEN (SR VICE PRESIDENT FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1010 N COUNTRY CLUB DR, MESA, AZ 85201-3309
(480) 834-1211
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
H-127
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020602
—
AZ
Enumeration date
07/10/2006
Last updated
08/22/2020
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