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General NPI Number Information
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NPI Number | 1063923340
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Entity Type | Organization
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Legal Business Name | BANNER HEALTH
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Dates
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Enumeration Date | 10/13/2017
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 807 S PONDEROSA ST
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City | PAYSON
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State | AZ
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Zip | 85541-5542
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Country | US
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Telephone | 928-471-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 N CENTRAL AVE STE 160
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City | PHOENIX
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State | AZ
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Zip | 85012-2702
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HOYT SKABELAND
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Credential |
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Telephone | 928-471-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0404X
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Taxonomy Name | Cardiac Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number |
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License Number State |
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