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NPI Code Detail

MEDICARE: BANNER HEALTH PHYSICIANS WEST LLC

MEDICARE: BANNER HEALTH PHYSICIANS WEST 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

General Provider Information

NPI Number : 1437596582
Entity Type Code : Organization
Provider Name (Legal Business Name) : BANNER HEALTH PHYSICIANS WEST 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 : 1260 NEVADA PACIFIC BLVD
Second Line :
City : FERNLEY
State : NV
Zip : 89408-9871
Country : US
Telephone Number : 775-575-7171
Fax Number : 775-575-7227
Authorized Official
Title or Position : CFO
Name : DENNIS LARAWAY
Credential :
Telephone Number : 602-747-4000
Provider Enumeration Date : 05/30/2013
Last Update Date : 01/13/2022

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Directions to “BANNER HEALTH PHYSICIANS WEST LLC ” Practice Location

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