MEDICARE: BANNER URGENT CARE SERVICES, 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
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1235601881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANNER URGENT CARE SERVICES, 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10330 N SCOTTSDALE RD STE 25
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85253-1427
Country	:	US
Telephone Number	:	602-255-7625
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	DENNIS LARAWAY
Credential	:
Telephone Number	:	602-747-4000

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	01/27/2022

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