Banner -- University Medical Center Phoenix Campus Internal Medicine

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS INTERNAL MEDICINE

Practice address

1300 N 12TH St
#610
Phoenix, AZ 85006-2848

Phone

(602) 239-4161

Fax

(602) 239-4233

NPI assigned

May 19, 2006

Organization subpart

Yes

Parent organization

BANNER HEALTHAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dennis E Dahlen

Title

Sr Vice President - Finance

Phone

(602) 747-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Big Horn Family Med

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Banner Health

  dba Banner Casa Grande Medical Center

  • General Acute Care Hospital
  • Casa Grande, AZ
  • NPI 1003232976

  Member Of

  NPD member

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard A Manch, M.D.

  • Hepatology Physician
  • Glendale, AZ
  • NPI 1043289341
  NPD (past)
• Mark Wong, MD

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1821054081
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1124071162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 N 12TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST",
            "address_2": "#610",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062848",
            "telephone_number": "602-239-4161",
            "fax_number": "602-239-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS INTERNAL MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2006-05-19",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "SR VICE PRESIDENT - FINANCE",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767858",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Banner -- University Medical Center Phoenix
• Banner -- University Medical Center Phoenix Campus
• Banner -- University Medical Center Phoenix Campus Behavioral Health
• Banner -- University Medical Center Phoenix Campus Critical Care
• Banner -- University Medical Center Phoenix Campus Family Medicine
• Banner -- University Medical Center Phoenix Campus Surgical Services
• Banner -- University Medical Center Phoenix Campus Toxicology
• Banner -- University Medical Center Phoenix Campus Trauma Services
• Banner -- University Medical Center Phoenix Campus Women's Services
• Banner -- University Medical Center PHX Campus Liver Disease Services

• Multi-Specialty Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Multi-Specialty Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.