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NPI Code Detail

MEDICARE: BANNER -- UNIVERSITY PRIMARY CARE PHYSICIANS LLC

MEDICARE: BANNER -- UNIVERSITY PRIMARY CARE PHYSICIANS LLC
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
1261QM1300XMulti-Specialty Clinic/Center
2261QP2300XPrimary Care Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154791960
Entity Type Code : Organization
Provider Name (Legal Business Name) : BANNER -- UNIVERSITY PRIMARY CARE PHYSICIANS LLC
Provider Business Mailing Address
First Line : 2901 N CENTRAL AVE STE 160
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2702
Country : US
Telephone Number : 602-747-4000
Fax Number :
Provider Business Practice Location Address
First Line : 807 S PONDEROSA ST
Second Line :
City : PAYSON
State : AZ
Zip : 85541-5542
Country : US
Telephone Number : 928-471-3222
Fax Number :
Authorized Official
Title or Position : CEO
Name : BENJAMIN SCHWARTZ
Credential :
Telephone Number : 602-747-4000
Provider Enumeration Date : 10/06/2015
Last Update Date : 04/13/2026

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