Banner Copper Basin Medical Clinic

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

BANNER COPPER BASIN MEDICAL CLINIC

Practice address

2474 E Hunt Hwy
Suite 10
Queen Creek, AZ 85143-5210

Phone

(480) 543-6680

NPI assigned

Jan 13, 2009

Last updated

Apr 11, 2011By 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

Big Horn Family Med

Member of 1

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

• Banner Health

  dba Banner Hospice of Northern Colorado

  • Community Based Hospice Care Agency
  • Greeley, CO
  • NPI 1407409964

  Member Of

  NPD member

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

{
    "created_epoch": "1231804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1265679260",
    "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": "2474 E HUNT HWY",
            "address_2": "SUITE 10",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851435210",
            "telephone_number": "480-543-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER COPPER BASIN MEDICAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2009-01-13",
        "last_updated": "2011-04-11",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Lee Baker
• Mark E Balch
• Praveen Chandar Balraj, MD
• Alice Banda, REGISTERED NURSE
• Amir Bankhead
• Banner Ironwood Medical Center
• Banner Ironwood Physicians
• Banner Physician Specialists Arizona LLC
• Banner Primary Care Physicians Arizona LLC
• Banner Primary Care Physicians Arizona LLC

• Multi-Specialty Clinic/Center in Queen Creek, AZ
• Providers in Queen Creek, 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 Apr 11, 2011; 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.