| Banner Arizona Medical Clinic Ltd | |
|
13640 N Plaza Del Rio Blvd Peoria AZ 85381-4846 | |
| (623) 876-3800 | |
| (623) 972-9590 |
| Full Name | Banner Arizona Medical Clinic Ltd |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 13640 N Plaza Del Rio Blvd, Peoria, Arizona |
| Authorized Official Name and Position | Dennis Dahlen (SR VICE PRESIDENT - FINANCE) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Arizona Medical Clinic Ltd 13640 N Plaza Del Rio Blvd Peoria AZ 85381-4846 Ph: (623) 876-3800 | Banner Arizona Medical Clinic Ltd 13640 N Plaza Del Rio Blvd Peoria AZ 85381-4846 Ph: (623) 876-3800 |
| NPI Number | 1750347936 |
|---|---|
| Provider Enumeration Date | 04/25/2006 |
| Last Update Date | 12/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750347936 | NPI | - | NPPES |
| 0516437 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | OTC3936 (Arizona) | Primary |
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