Banner Mesa Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BANNER MESA SURGERY CENTER LLC

Practice address

1500 S Dobson Rd Ste 101
Mesa, AZ 85202-4722

Phone

(480) 306-6098

Fax

(602) 801-3815

NPI assigned

Aug 9, 2017

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

Matthew Cox

Title

Sr VP Finance

Phone

(602) 747-4000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Listed as

Banner Desert Surgery CenterCCN 03C0001203

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

M E Lee MD

Member of 1

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

• Banner Health

  • Critical Access Hospital
  • Payson, AZ
  • NPI 1063923340

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564099200000",
    "number": "1780109934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S DOBSON RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024722",
            "telephone_number": "480-306-6098",
            "fax_number": "602-801-3815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER MESA SURGERY CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2017-08-09",
        "last_updated": "2019-07-26",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "SR VP FINANCE",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Banner Medical Group Adult Sleep, LLC
• Banner Medical Group Pediatric Sleep, LLC
• Banner Mesa Medical Center
• Banner Mesa Medical Center
• Banner Mesa Medical Center
• Banner Occupational Health Arizona LLC
• Banner Pediatric Specialists LLC
• Banner Pharmacy Services LLC
• Banner Pharmacy Services LLC
• Banner Pharmacy Services LLC

• Ambulatory Surgical Clinic/Center in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.