Banner Good Samaritan Liver Disease Center

Key facts

NPI

1154639797

Entity type

Organization (NPI type 2)

Primary specialty

Multi-Specialty Clinic/Center 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

Organization subpart

Yes

Parent organization (as reported)

BANNER HEALTH

Authorized official

Name

Dennis E Dahlen

Title

Sr VP Finance

Phone

(602) 747-4000

National Provider Directory

Part of

M E Lee MD

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 3, 2015.

{
    "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": []
}

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