MEDICARE: TOCA AT BANNER HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
2	208100000X	Physical Medicine & Rehabilitation Physician
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1427672534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOCA AT BANNER HEALTH 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	:	18700 N 64TH DR STE 220
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7112
Country	:	US
Telephone Number	:	602-277-6211
Fax Number	:

Authorized Official
Title or Position	:	BANNER MEDICAL GROUP, CEO
Name	:	SHIVA BIRDI
Credential	:
Telephone Number	:	480-256-3336

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	04/16/2026

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