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General NPI Number Information
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NPI Number | 1073223012
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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 | 11/30/2022
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 117 E MAIN ST STE A100
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City | PAYSON
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State | AZ
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Zip | 85541-4606
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Country | US
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Telephone | 928-596-4500
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Fax | 928-596-4545
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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 SKABELUND
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Credential |
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Telephone | 602-747-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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