Active NPI
Banner Phoenix Internal Medicine Physicians
- Medical Specialty Clinic/Center
- Phoenix, AZ
National Provider Identifier
1902017346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Specialty Clinic/Center
- License
- PENDING
- Legal business name
- BANNER PHOENIX INTERNAL MEDICINE PHYSICIANS
- Practice address
- 4400 N 32ND St
Suite 140
Phoenix, AZ 85018-3953 - Phone
- (602) 254-4424
- NPI assigned
- May 25, 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
- Dennis E Dahlen
- Title
- Sr VP Finance
- Phone
- (602) 747-4000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | PENDING | Primary |
Addresses
Primary practice location
4400 N 32ND St
Suite 140
Phoenix, AZ 85018-3953
Mailing address
1441 N 12TH St
Phoenix, AZ 85006-2837
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 255741 | 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": "1180051200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1201132800000",
"number": "1902017346",
"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": "4400 N 32ND ST",
"address_2": "SUITE 140",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850183953",
"telephone_number": "602-254-4424"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BANNER PHOENIX INTERNAL MEDICINE PHYSICIANS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BANNER HEALTH",
"enumeration_date": "2007-05-25",
"last_updated": "2008-01-24",
"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": "261QM2500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Medical Specialty",
"state": null,
"license": "PENDING",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "255741",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
- Banner Pharmacy Services LLC
- Banner Pharmacy Services LLC
- Banner Pharmacy Services LLC
- Banner Pharmacy Services LLC
- Banner Pharmacy Services LLC
- Banner Phoenix Surgery Center LLC
- Banner Physician Specialists Arizona LLC
- Banner Physician Specialists Arizona LLC
- Banner Physician Specialists Arizona LLC
- Banner Physician Specialists Arizona LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.