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
1	261QP2300X	Primary Care Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC6470	OTHER	AZ	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508809427
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2700
Country	:	US
Telephone Number	:	602-747-4000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BENJAMIN SCHWARTZ
Credential	:
Telephone Number	:	602-747-4000

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/24/2025

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Directions to “BANNER-UNIVERSITY MEDICAL GROUP ” Practice Location

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