BANNER GOOD SAMARITAN LIVER DISEASE CENTER (NPI# 1154639797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154639797 |
| Entity Type | Organization |
| Organization Name | BANNER GOOD SAMARITAN LIVER DISEASE CENTER |
| Practice Address |
117 E Main St Suite A Payson AZ 85541-5293 |
| Mailing Address |
1441 N 12th St Phoenix AZ 85006-2837 |
| Practice Telephone | 6028394123 |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2015-03-03 |
| Authorized Official Name | DENNIS E DAHLEN (SR VP FINANCE) |
| Authorized Official Telephone | 6027474000 |
| Is Organization Subpart | Y |
| Parent Organization Name | BANNER HEALTH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Street Address |
117 E MAIN ST SUITE A |
| City | PAYSON |
| State | AZ |
| Zip Code | 85541-5293 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629407945 | Jessica Rae Parker | Physician Assistant | 117 E Main St, Suite A 100, Payson, AZ 85541-5293 | 2013-11-07 |
| 1851624506 | Smi Imaging, LLC | Radiology | 117 E Main St, Bldg D, Suite 100, Payson, AZ 85541-5293 | 2009-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447805130 | Melissa Marie Avery | Registered Nurse | 903 Az-260, Payson, AZ 85541 | 2019-08-08 |
| 1952803710 | Payson Orthodontics | Dentist | 902 S Beeline Hwy, Payson, AZ 85541 | 2018-03-07 |
| 1568844181 | Banner Home Care Arizona | Home Health | 708 E Route 260 Ste A1, Payson, AZ 85541 | 2015-06-19 |
| 1063893626 | Sage Counseling, Inc. | Community/Behavioral Health | 1100 N. Beeline Hwy, Suite F, Payson, AZ 85541 | 2015-06-09 |
| 1053712059 | Garry Gordon | Homeopath | 600 N Beeline Hwy, Payson, AZ 85541 | 2014-09-09 |
| 1821406901 | Monica Nestich | Physical Therapy Assistant | 708 E. State Hwy 260, Payson, AZ 85541 | 2014-08-01 |
| 1841601523 | Megan Fragale Saalfrank | Pharmacist | 401 E. Highway 260, Payson, AZ 85541 | 2014-05-15 |
| 1750791836 | Caring Connections for Special Needs, LLC | Community/Behavioral Health | 600 E. Highway 260, Suite 4 & 5, Payson, AZ 85541 | 2014-04-29 |
| 1164775169 | Kc's Home Health Care LLC of Payson | Home Health | 114 E. Highway 260, Payson, AZ 85541 | 2012-10-16 |
| 1598014458 | Ivan D. Mclaws, Dpm | Podiatrist | 200 East Lone Pine Dr., Payson, AZ 85541 | 2012-09-06 |
| Find all providers in zip 85541 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568074870 | Fitz Ilias Inc | Clinic/Center | 600 E State Highway 260 Ste 2, Payson, AZ 85541-4967 | 2020-08-18 |
| 1285278077 | Banner Childrens Banner Health Clinic LLC | Clinic/Center | 117 E Main St Ste A100, Payson, AZ 85541-4606 | 2019-11-05 |
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|---|---|---|---|---|
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| 1659970242 | Orthopedic Specialists of North America Pllc | Clinic/Center | 33300 N 32nd Ave, Phoenix, AZ 85085-8877 | 2020-10-23 |
| 1689273542 | Orthopedic Specialists of North America Pllc | Clinic/Center | 33400 N 32nd Ave Fl 1, Phoenix, AZ 85085-8876 | 2020-10-21 |
| 1629676317 | Bethel Hills Integrated Healthcare | Clinic/Center | 13838 S 46th Pl Ste 300, Phoenix, AZ 85044-7804 | 2020-10-14 |
| 1639786585 | Crossover Health Medical Group | Clinic/Center | 1847 E Southern Ave Ste 3, Tempe, AZ 85282-5881 | 2020-09-24 |
| 1821605775 | Crossover Health Medical Group | Clinic/Center | 5251 W Campbell Ave Ste 200, Phoenix, AZ 85031-1719 | 2020-09-24 |
| 1649887597 | Crossover Health Medical Group | Clinic/Center | 8343 W Van Buren St Bldg C-2, Tolleson, AZ 85353-3225 | 2020-09-24 |
| 1235745464 | Vasco Healthcare Inc | Clinic/Center | 2110 W 24th St Ste A, Yuma, AZ 85364-8878 | 2020-09-22 |
| 1265048490 | Vasco Healthcare Inc | Clinic/Center | 8952 E Desert Cove Ave Ste 204, Scottsdale, AZ 85260-6777 | 2020-09-22 |
| 1942816160 | Vasco Healthcare Inc | Clinic/Center | 13026 W Rancho Santa Fe Blvd Ste B100, Avondale, AZ 85392-1712 | 2020-09-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.