NPIMap

Organization Active NPI

Banner Arizona Medical Clinic LTD

  • Multi-Specialty Clinic/Center
  • Peoria, AZ
National Provider Identifier
1750347936
Registry record updated Dec 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
OTC3936 Issued in AZ
Legal business name
BANNER ARIZONA MEDICAL CLINIC LTD
Practice address
13640 N Plaza del Rio Blvd
Peoria, AZ 85381-4846
Phone
(623) 876-3800
Fax
(623) 972-9590
NPI assigned
Apr 25, 2006
Last updated
Dec 3, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dennis Dahlen
Title
Sr Vice President - Finance
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X OTC3936 AZ Primary

Addresses

Primary practice location

13640 N Plaza del Rio Blvd
Peoria, AZ 85381-4846

Mailing address

13640 N Plaza del Rio Blvd
Peoria, AZ 85381-4846
Phone (623) 876-3800

Other identifiers 1

IdentifierTypeStateIssuer
0516437MedicaidAZ

National Provider Directory

National Provider Directory
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

Locations

13640 N Plaza del Rio Blvd
Ste 230
Peoria, AZ 85381
Phone (623) 876-3810

Practitioners & affiliated clinicians

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228262400000",
    "number": "1750347936",
    "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",
            "fax_number": "623-972-9590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13640 N PLAZA DEL RIO BLVD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814846",
            "telephone_number": "623-876-3800",
            "fax_number": "623-972-9590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER ARIZONA MEDICAL CLINIC LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2006-04-25",
        "last_updated": "2008-12-03",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "DENNIS",
        "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": "AZ",
            "license": "OTC3936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0516437",
            "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 Dec 3, 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.

Verify at the official NPI Registry.