BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC; NPI #1790337665

Contact Information

BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC

1450 S DOBSON RD STE B221
MESA, AZ 85202-4745

Phone: 480-827-5370
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Nutrition, Education	133NN1002X
Multi-Specialty	261QM1300X	70	Clinic or Group Practice

Indicates primary specialty

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NPI Profile & details for BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC

NPI #	`1790337665`
LBN Legal business name	BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
Authorized official	DENNIS LARAWAY - (CFO)
Entity	Organization
Organization subpart ¹	Yes
Enumeration date	07/11/2019
Last updated	12/28/2021 - About 4 years ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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