Active NPI
Banner -- University Medical Center Phoenix Campus Family Medicine
- Family Medicine Physician
- Phoenix, AZ
National Provider Identifier
1124073747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS FAMILY MEDICINE
- Practice address
- 1300 N 12TH St
Ste 605
Phoenix, AZ 85006-2848 - Phone
- (602) 239-4567
- Fax
- (602) 239-2067
- NPI assigned
- May 23, 2006
- Last updated
- Feb 26, 2015
- Organization subpart
- Yes
- Parent organization
- BANNER HEALTH
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
1300 N 12TH St
Ste 605
Phoenix, AZ 85006-2848
Mailing address
1441 N 12TH St
Phoenix, AZ 85006-2837
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 767618 | Medicaid | AZ |
National Provider Directory
National Provider Directory- Part of
- M E Lee MD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1424908800000",
"number": "1124073747",
"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": "STE 605",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062848",
"telephone_number": "602-239-4567",
"fax_number": "602-239-2067"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS FAMILY MEDICINE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BANNER HEALTH",
"enumeration_date": "2006-05-23",
"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": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "767618",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
- Banner -- University Dental Services LLC
- 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 Internal 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
Sources for this page
- 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.