BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS INTERNAL MEDICINE
NPI 1124071162
Clinic/Center - Multi-Specialty in Phoenix, AZ
- Organization
- Clinic/Center
- Multi-Specialty
- CLIA Number: 03D0526278
- CLIA Cert. Type: Ancillary Testing Site in Health Care Center
- CLIA Exp. Date: 11-03-2026
About BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS INTERNAL MEDICINE
This page provides the complete NPI Profile along with additional information for Banner -- University Medical Center Phoenix Campus Internal Medicine, a provider established in Phoenix, Arizona operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1124071162 assigned on May 2006. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated 11 years ago. The authorized official of this NPI record is Dennis E Dahlen (Sr Vice President - Finance)
- NPI
- 1124071162 Verify this NPI
- Provider Name
- BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS INTERNAL MEDICINE
- Entity Type
- Organization
- Location Address
- 1300 N 12TH ST #610 PHOENIX, AZ 85006
- Location Phone
- (602) 239-4161
- Location Fax
- (602) 239-4233
- Mailing Address
- 1441 N 12TH ST PHOENIX, AZ 85006
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 05-19-2006
- Last Update Date
- 02-26-2015
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Multi-Specialty
- Taxonomy Code
- 261QM1300X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| Z73965 | MEDICARE PIN (08) | AZ | |
| 767858 | MEDICAID (05) | AZ | |
| Z106229 | MEDICARE PIN (08) | AZ | |
| Z106232 | MEDICARE PIN (08) | AZ | |
| Z79775 | MEDICARE PIN (08) | AZ |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 03D0526278
- Facility Type
- Ancillary Testing Site in Health Care Center
- Certificate Effective Date
- November 04, 2024
- Certificate Expiration Date
- November 03, 2026
- Laboratory Director
- DR. SURESH UPPALAPU
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Banner -- University Medical Center Phoenix Campus Internal Medicine on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
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Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1124071162, enumerated as an "organization" on May 19, 2006.
The provider is located at 1300 N 12TH ST #610 PHOENIX, AZ 85006 and the phone number is (602) 239-4161.
Clinic/Center with taxonomy code 261QM1300X and a focus in Multi-Specialty.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
