MEDICARE: BANNER SURGERY CENTER - ALVERNON 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1922660109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANNER SURGERY CENTER - ALVERNON LLC

Provider Business Mailing Address
First Line	:	2355 E CAMELBACK RD STE 700
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-9044
Country	:	US
Telephone Number	:	602-358-8512
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 N ALVERNON WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1804
Country	:	US
Telephone Number	:	480-292-8541
Fax Number	:	602-926-0412

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	MR. BRETT WALTON
Credential	:
Telephone Number	:	909-212-1708

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	03/17/2026

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