Active NPI
Banner Arizona Medical Clinic LTD
- Durable Medical Equipment & Medical Supplies
- Peoria, AZ
National Provider Identifier
1487785002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- OTC3932
- Legal business name
- BANNER ARIZONA MEDICAL CLINIC LTD
- Practice address
- 13760 N 93Rd Ave
Peoria, AZ 85381-4201 - Phone
- (623) 876-3952
- Fax
- (623) 876-3975
- NPI assigned
- Mar 7, 2007
- 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
- Margaret Burke
- Title
- Chief Financial Officer
- Phone
- (623) 876-3967
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | OTC3932 | AZ | Primary |
| Prosthetic/Orthotic Supplier | 335E00000X | OTC3932 | AZ |
Addresses
Primary practice location
13760 N 93Rd Ave
Peoria, AZ 85381-4201
Mailing address
13640 N Plaza del Rio Blvd
Peoria, AZ 85381-4846
Phone (623) 876-3800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 516437 | 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": "1173225600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1221782400000",
"number": "1487785002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13640 N PLAZA DEL RIO BLVD",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853814846",
"telephone_number": "623-876-3800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13760 N 93RD AVE",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853814201",
"telephone_number": "623-876-3952",
"fax_number": "623-876-3975"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BANNER ARIZONA MEDICAL CLINIC LTD",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BANNER HEALTH",
"enumeration_date": "2007-03-07",
"last_updated": "2008-09-19",
"status": "A",
"authorized_official_last_name": "BURKE",
"authorized_official_first_name": "MARGARET",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "623-876-3967"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "AZ",
"license": "OTC3932",
"primary": true
},
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "AZ",
"license": "OTC3932",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "516437",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.