Organization · Type 2 NPI

Banner Health

Non-Pharmacy Dispensing Site · Phoenix, AZ

NPI number 1316358013 Active

Practice location

1300 N 12th St, Suite 605
Phoenix, AZ 85006-2848

Call (602) 839-2668 Map

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702

Specialties and licenses

Taxonomy	Code	License
Non-Pharmacy Dispensing Site Primary	332900000X	45424 (AZ)

Non-Pharmacy Dispensing Site: A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

142 other providers at this address

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NPI record

NPI: 1316358013
Entity type: Organization (Type 2)
Issued: May 15, 2014
Last updated: Jan 31, 2022
Status: Active
Subpart: Yes of Medvantx, Inc.

Other names

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Good Samaritan Medicine Residency 12th ST · doing business as
Good Samaritan Medicine Residency 12th ST · doing business as

Authorized official

Dennis Laraway
CFO
(602) 747-4000

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1316358013

Banner Health's National Provider Identifier is 1316358013, issued on May 15, 2014. The primary taxonomy on file is Non-Pharmacy Dispensing Site (332900000X), and the practice location is in Phoenix, AZ. The record was last updated on Jan 31, 2022.