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Banner Health — NPI 1316358013, Phoenix, AZ | NPI Central

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NPI 1316358013

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Banner Health

NPI 1316358013 · Non-Pharmacy Dispensing Site · Phoenix, AZ

Provider details

NPI number: 1316358013
Entity type: Organization
Primary specialty: Non-Pharmacy Dispensing SiteSuppliers
Parent organization: Medvantx, Inc.
Organization subpart: Yes
Authorized official: Dennis Laraway, Cfo(602) 747-4000
License: 45424 (AZ)

Specialties & taxonomies

Non-Pharmacy Dispensing SitePrimary332900000XLicense 45424 (AZ)
Suppliers

Practice location

1300 N 12th St

Suite 605

Phoenix, AZ 85006-2848

Phone: (602) 839-2668

Approximate (ZIP-level) locationGet directions

More AZ providers

Mailing address

2901 N Central Ave Ste 160

Phoenix, AZ 85012-2702

Other names (DBA / former)

Doing business as: Good Samaritan Medicine Residency 12th St
Doing business as: Good Samaritan Medicine Residency 12th St

Registry dates

Enumerated: 2014-05-15
Last updated: 2022-01-31
Certified: 2022-01-31

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.