Banner Good Samaritan Liver Disease Center

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

BANNER GOOD SAMARITAN LIVER DISEASE CENTER

Practice address

117 E Main St
Suite a
Payson, AZ 85541-5293

Phone

(602) 839-4123

NPI assigned

Sep 16, 2010

Last updated

Mar 3, 2015By the provider in NPPES

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 VP Finance

Phone

(602) 747-4000

Specialties & licenses 1

Addresses

Part of

Custer Comm Hosp Rad

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425340800000",
    "number": "1154639797",
    "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": "117 E MAIN ST",
            "address_2": "SUITE A",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415293",
            "telephone_number": "602-839-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER GOOD SAMARITAN LIVER DISEASE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2010-09-16",
        "last_updated": "2015-03-03",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "SR VP 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": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Marie Avery, RN
• Jessica L Balcom, FNP-C
• Matthew Balls, DO
• Banner -- University Primary Care Physicians LLC
• Banner Cancer Center Specialists LLC
• Banner Health (Banner Payson Medical Center)
• Banner Health (Banner Payson Medical Center)
• Banner Health (Banner Payson Medical Center - Banner Health Clinic Payson)
• Banner Health (Banner Payson Medical Center)
• Banner Health (Banner Same-Day Care)

• Multi-Specialty Clinic/Center in Payson, AZ
• Providers in Payson, 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 Mar 3, 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.