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NPI Code Detail

MEDICARE: BANNER THUNDERBIRD MEDICAL CENTER

MEDICARE: BANNER THUNDERBIRD MEDICAL CENTER
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
1273R00000XPsychiatric Hospital Unit

General Provider Information

NPI Number : 1699829929
Entity Type Code : Organization
Provider Name (Legal Business Name) : BANNER THUNDERBIRD MEDICAL CENTER
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 : 5555 W THUNDERBIRD RD
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-4622
Country : US
Telephone Number : 602-865-5555
Fax Number : 602-865-5930
Authorized Official
Title or Position : CEO
Name : DALE JOHNS
Credential :
Telephone Number : 602-747-4000
Provider Enumeration Date : 01/23/2007
Last Update Date : 04/17/2026

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