Healthcare Provider Details

I. General information

NPI: 1164897849
Provider Name (Legal Business Name): BANNING MEDICAL SERVICES, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HIGHLAND SPRINGS AVE
BANNING CA
92220-3046
US

IV. Provider business mailing address

PO BOX 99008
LAS VEGAS NV
89193-9008
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-5000
  • Fax: 877-250-6889
Mailing address:
  • Phone: 954-939-5000
  • Fax: 877-250-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VAUGHN
Title or Position: OFFICER
Credential:
Phone: 404-450-4684