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NPI Code Detail

MEDICARE: BANNER-UNIVERSITY MEDICAL GROUP

MEDICARE: BANNER-UNIVERSITY MEDICAL GROUP
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
2133NN1002XNutrition Education Nutritionist

General Provider Information

NPI Number : 1508673682
Entity Type Code : Organization
Provider Name (Legal Business Name) : BANNER-UNIVERSITY MEDICAL GROUP
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 : 8290 S HOUGHTON RD STE 150
Second Line :
City : TUCSON
State : AZ
Zip : 85747-9725
Country : US
Telephone Number : 520-874-3111
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : BENJAMIN SCHWARTZ
Credential :
Telephone Number : 602-747-4000
Provider Enumeration Date : 12/12/2024
Last Update Date : 11/24/2025

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Directions to “BANNER-UNIVERSITY MEDICAL GROUP ” Practice Location

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