Banner Good Samaritan Outpatient Clinic

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

BANNER GOOD SAMARITAN OUTPATIENT CLINIC

Practice address

925 E McDowell Rd
Phoenix, AZ 85006-2502

Phone

(602) 239-4777

Fax

(602) 239-5806

NPI assigned

May 18, 2006

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 Vice President - Finance

Phone

(602) 747-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

M E Lee MD

Member of 1

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

• Banner Health

  dba Banner Payson Medical Center

  • Critical Access Hospital
  • Payson, AZ
  • NPI 1063923340

  Member Of

  NPD member

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1609829019",
    "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": "925 E MCDOWELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062502",
            "telephone_number": "602-239-4777",
            "fax_number": "602-239-5806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER GOOD SAMARITAN OUTPATIENT CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2006-05-18",
        "last_updated": "2007-10-15",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767824",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Banner Family Pharmacy
• Banner Family Pharmacy (Banner Family Pharmacy - Estrella)
• Banner Good Samaritan
• Banner Good Samaritan Bariatric Program
• Banner Good Samaritan Medical Center
• Banner Health
• Banner Health (Banner Family Pharmacy)
• Banner Health (Good Samaritan Medicine Residency 12th St)
• Banner Health (Banner Health Clinic-32nd St Internal Medicine)
• Banner Health (Banner Good Samaritan Op Clinic Pharmacy)

• Multi-Specialty Clinic/Center in Phoenix, AZ
• Providers in Phoenix, 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 Oct 15, 2007; 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.