MEDICARE: BANNER HOSPITAL BASED PHYSICIANS ARIZONA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1316294242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANNER HOSPITAL BASED PHYSICIANS ARIZONA LLC

Provider Business Mailing Address
First Line	:	2901 N CENTRAL AVE STE 160
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N NAVAJO
Second Line	:	MAILING PO BOX 1447 PAGE 86040-1447
City	:	PAGE
State	:	AZ
Zip	:	86040
Country	:	US
Telephone Number	:	928-645-0112
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHIVA BIRDI
Credential	:
Telephone Number	:	602-747-4000

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	04/16/2026

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