Organization
BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Active
Parent organization
BANNER MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP
Authorized official
SHIVA BIRDI (CEO/BMG)
(602) 747-4000
Entity
Organization
Contact information
Practice address
4375 E IRMA LN, PHOENIX, AZ 85050-4312
(480) 890-5800
(480) 890-5920
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
08/15/2022
Last updated
08/15/2022
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