MEDICARE: BANNER ESTRELLA SURGERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	OSC5846	AZ

General Provider Information

NPI Number	:	1114962321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANNER ESTRELLA SURGERY CENTER

Provider Business Mailing Address
First Line	:	1441 N 12TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:	602-747-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9301 W THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3327
Country	:	US
Telephone Number	:	623-388-5700
Fax Number	:	623-478-7499

Authorized Official
Title or Position	:	SR VICE PRESIDENT FINANCE
Name	:	DENNIS E DAHLEN
Credential	:
Telephone Number	:	602-747-4000

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	12/18/2014

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