MEDICARE: BANNER PHYSICIAN SPECIALISTS ARIZONA 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1477301364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANNER PHYSICIAN SPECIALISTS ARIZONA 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	:	37100 N GANTZEL RD STE 107
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85140-7350
Country	:	US
Telephone Number	:	602-747-4000
Fax Number	:

Authorized Official
Title or Position	:	CEO/BMG
Name	:	SHIVA BIRDI
Credential	:
Telephone Number	:	602-747-4000

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	09/06/2024

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