| Banner - University Hospital Based Physicians Llc | |
|
1111 E Mcdowell Rd Phoenix AZ 85006-2612 | |
| (602) 839-3749 | |
| Not Available |
| Full Name | Banner - University Hospital Based Physicians Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1111 E Mcdowell Rd, Phoenix, Arizona |
| Authorized Official Name and Position | Todd Werner (DIVISION PRESIDENT) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner - University Hospital Based Physicians Llc 2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 Ph: () - | Banner - University Hospital Based Physicians Llc 1111 E Mcdowell Rd Phoenix AZ 85006-2612 Ph: (602) 839-3749 |
| NPI Number | 1013627967 |
|---|---|
| Provider Enumeration Date | 12/01/2022 |
| Last Update Date | 12/01/2022 |
| Medicare PECOS PAC ID | 1052614294 |
|---|---|
| Medicare Enrollment ID | O20230615002275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013627967 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QR0200X | Clinic/center - Radiology | (* (Not Available)) | Primary |
| Provider Name | Gregory L Thalken |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861547317 PECOS PAC ID: 9830333541 Enrollment ID: I20190109002556 |
| Provider Name | Shareef M Riad |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417111477 PECOS PAC ID: 0042353336 Enrollment ID: I20201012002183 |
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