Healthcare Provider Details

I. General information

NPI: 1831733716
Provider Name (Legal Business Name): BANNER URGENT CARE ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3457 W WHITE MOUNTAIN BLVD
LAKESIDE AZ
85929-6007
US

IV. Provider business mailing address

2901 N CENTRAL AVE STE 160
PHOENIX AZ
85012-2702
US

V. Phone/Fax

Practice location:
  • Phone: 928-358-1515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN STANDAGE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 602-747-4000