1306908355 NPI number — BANNER -- UNIVERSITY MEDICAL CENTER TUCSON CAMPUS LLC

Table of content: (NPI 1306908355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306908355 NPI number — BANNER -- UNIVERSITY MEDICAL CENTER TUCSON CAMPUS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BANNER -- UNIVERSITY MEDICAL CENTER TUCSON CAMPUS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306908355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 N CENTRAL AVE STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-2702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 N. CAMPBELL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-694-6501
Provider Business Practice Location Address Fax Number:
520-694-4085
Provider Enumeration Date:
12/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LARAWAY
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
602-747-4000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336I0012X , with the licence number: H-0134 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0366400001 . This is a "DME RETAIL PHARMACY" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".