Healthcare Provider Details

I. General information

NPI: 1326882101
Provider Name (Legal Business Name): BANNER - UNIVERSITY HOSPITAL BASED PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 602-747-4000
  • Fax:
Mailing address:
  • Phone: 602-747-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VENKATA EVANI
Title or Position: PRESIDENT
Credential:
Phone: 602-747-4000