BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC (NPI# 1578125738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578125738 |
| Entity Type | Organization |
| Organization Name | BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC |
| Practice Address |
5310 W Thunderbird Rd Ste 214 Glendale AZ 85306-4722 |
| Mailing Address |
2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 |
| Practice Telephone | 6028654480 |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2019-07-08 |
| Authorized Official Name | DENNIS LARAWAY (CFO) |
| Authorized Official Telephone | 6027474000 |
| Is Organization Subpart | Y |
| Parent Organization Name | BANNER HEALTH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
| Y | 133NN1002X |
Nutritionist Specialization: Nutrition, Education |
Dietary & Nutritional Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790337665 | Banner Physician Super Specialists Arizona LLC | Clinic/Center | 1450 S Dobson Rd Ste B221, Mesa, AZ 85202-4745 | 2019-07-11 |
| 1396014403 | Banner Physician Super Specialists Arizona LLC | Clinic/Center | 37100 N Gantzel Rd, Ste 113, San Tan Valley, AZ 85140-7349 | 2011-12-19 |
| 1841573870 | Banner Physician Super Specialists Arizona LLC | Clinic/Center | 1432 S Dobson Rd, Mesa, AZ 85202-4768 | 2011-09-26 |
| Street Address |
5310 W THUNDERBIRD RD STE 214 |
| City | GLENDALE |
| State | AZ |
| Zip Code | 85306-4722 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548784648 | Michelle Weissgerber | Registered Nurse | 6640 W Maui Ln, Glendale, AZ 85306 | 2017-07-31 |
| 1427502947 | Az Interact LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6055 West Caribe Lane, Glendale, AZ 85306 | 2016-08-12 |
| 1649667635 | Richard Moreno Jr. | Physical Therapy Assistant | 6509 W Acapulco Ln, Glendale, AZ 85306 | 2015-04-17 |
| 1568863819 | Alternative Living for You | Assisted Living Facility | 5328 W. Tierra Buena Ln., Glendale, AZ 85306 | 2014-09-05 |
| 1649614561 | Matthew Brownell | Internal Medicine | 5555 W, Thunderbird, Banner Thunderbird Medical Center, Glendale, AZ 85306 | 2013-04-22 |
| 1366736266 | Miles Christenson | Speech-Language Pathologist | 14627 N 60th Ave, Glendale, AZ 85306 | 2011-06-08 |
| 1285928721 | Nathalie Tania Petein-alamshaw | Internal Medicine | 5555 W Thunderbird Road, Glendale, AZ 85306 | 2011-06-01 |
| 1134351869 | William J. Duff | Counselor | 5701 W. Talavi Boulevard, Suite 180, Phoenix, AZ 85306 | 2009-08-13 |
| 1538321369 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 5422 W. Thunderbird, Suite 8, Glendale, AZ 85306 | 2008-07-02 |
| 1316109143 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 5620 W. Thunderbird, Suite D3, Glendale, AZ 85306 | 2008-07-02 |
| Find all providers in zip 85306 | ||||
| Taxonomy Code | 133NN1002X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Nutritionist |
| Specialization | Nutrition, Education |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962766881 | Jennifer Nicole Hathwell | Nutritionist | 1020 Raleigh St, Glendale, CA 91205-1813 | 2012-06-26 |
| 1598955056 | Nurture Life | Nutritionist | 1001 E Colorado St, Inside World Gym, Glendale, CA 91205-1225 | 2007-07-30 |
| 1811261266 | Anahit Hovhannisyan | Nutritionist | 1500 S Central Ave, 321, Glendale, CA 91204-2530 | 2012-03-02 |
| 1437385416 | Diabetes and Heart Health Consultants LLC | Nutritionist | 20100 N 51st Ave, Suite #f640, Glendale, AZ 85308-5125 | 2009-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164029385 | Charlotte Marie Mcintyre | Nutritionist | 1000 E Water St Apt 7, Tucson, AZ 85719-3075 | 2020-10-01 |
| 1881219707 | Gabrielle Hungate | Nutritionist | 10754 N Chapin Ct, Tucson, AZ 85737-6634 | 2020-06-16 |
| 1538780598 | Penny Jean Stadick | Nutritionist | 20259 N Ryans Trl, Maricopa, AZ 85138-2446 | 2020-04-30 |
| 1275099020 | David Medansky | Nutritionist | 11980 W Shifting Sands Dr, Peoria, AZ 85383-2623 | 2019-02-18 |
| 1306345780 | Christine Inez Cintron | Nutritionist | 9231 E Carol Ave, Mesa, AZ 85208-2497 | 2018-02-12 |
| 1285143115 | Charles Higgins Jr. | Nutritionist | 600 N 4th St Apt 272, Phoenix, AZ 85004-4485 | 2017-09-22 |
| 1326568486 | Damian Dube | Nutritionist | 1503 N Rockwell St, Gilbert, AZ 85234-1436 | 2017-06-20 |
| 1427593391 | Martha Imelda Huizar | Nutritionist | 2214 E Vera Cruz Vis, Tucson, AZ 85713-5199 | 2016-12-30 |
| 1639622434 | Jenny Woelk | Nutritionist | 2757 S Pewter Dr, 102, Gilbert, AZ 85295-1282 | 2016-07-27 |
| 1356790158 | Banner Umc Dpec | Nutritionist | 3950 S Country Club Road, Suite 130, Tucson, AZ 85714 | 2016-06-13 |
| Find all providers with the same taxonomy | ||||
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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.