MEDICARE: BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX

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	273Y00000X	Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1467506857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX

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	:	1012 E WILLETTA ST FL 3
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2749
Country	:	US
Telephone Number	:	602-239-2361
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	12/23/2021

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