| Banner Primary Care Physicians Arizona Llc | |
|
601 N Navajo Page AZ 86040 | |
| (928) 645-0740 | |
| (928) 645-0753 |
| Full Name | Banner Primary Care Physicians Arizona Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 601 N Navajo, Page, Arizona |
| Authorized Official Name and Position | Dennis Laraway (CFO) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Primary Care Physicians Arizona Llc 2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 Ph: () - | Banner Primary Care Physicians Arizona Llc 601 N Navajo Page AZ 86040 Ph: (928) 645-0740 |
| NPI Number | 1710234703 |
|---|---|
| Provider Enumeration Date | 08/08/2012 |
| Last Update Date | 12/30/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710234703 | NPI | - | NPPES |
| 646505 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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