BANNER TELEHEALTH LLC
Complete NPI Record 1396492005
Clinic/Center - Mental Health (Including Community Mental Health Center) in Scottsdale, AZ
Active since March 03, 2022CLIA Certified · 3 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Banner Telehealth Llc (NPI 1396492005), a clinic/center organization in Scottsdale, AZ. All 32 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1396492005 Field 1/32
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/32
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/32
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: BANNER TELEHEALTH LLC Field 4/32
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 2901 N CENTRAL AVE STE 160 Field 5/32
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: PHOENIX Field 6/32
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: AZ Field 7/32
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 850122702 Field 8/32
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/32
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider First Line Business Practice Location Address: 7575 E EARLL DR STE 101 Field 10/32
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: SCOTTSDALE Field 11/32
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: AZ Field 12/32
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 852516915 Field 13/32
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 14/32
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 4806848345 Field 15/32
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 4804125477 Field 16/32
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: WERNER Field 19/32
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: TODD Field 20/32
- The first name of the authorized official.
- Authorized Official Title or Position: DIVISION PRESIDENT Field 21/32
- The title or position of the authorized official.
- Authorized Official Telephone Number: 6024744000 Field 22/32
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 261Q00000X Field 23/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 24/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 261QM0850X Field 25/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 26/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 261QM0801X Field 27/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: Y Field 28/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: Y Field 29/32
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Parent Organization LBN: BANNER HEALTH Field 30/32
- The Legal Business Name (LBN) of the parent organization, if the provider is a subpart of a larger entity. This field identifies the official registered name of the parent company or organization under which the provider operates.
- Parent Organization TIN: Not available Field 31/32
- The Taxpayer Identification Number (TIN) of the parent organization, provided when the provider is a subpart of a larger entity. This field identifies the federal tax ID used by the parent organization for official and billing purposes.
Secondary Practice Locations 17
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
9201 W Thomas Rd
Location 1/17Phoenix, AZ 85037-3332 · Phone (623) 327-4000
501 N Navajo Dr
Location 2/17Page, AZ 86040-0959 · Phone (928) 645-2424
5555 W Thunderbird Rd
Location 3/17Glendale, AZ 85306-4622 · Phone (602) 865-5555
807 S Ponderosa St
Location 4/17Payson, AZ 85541-5542 · Phone (928) 471-3222
1405 S Alma School Rd
Location 5/17Chandler, AZ 85286-7144 · Phone (480) 256-7000
37000 N Gantzel Rd
Location 6/17Queen Creek, AZ 85140-7303 · Phone (480) 394-4000
2050 W Southern Ave
Location 7/17Apache Junction, AZ 85120-7305 · Phone (480) 733-3300
1900 N Higley Rd
Location 8/17Gilbert, AZ 85234-1604 · Phone (480) 543-2000
1400 S Dobson Rd
Location 9/17Mesa, AZ 85202-4707 · Phone (480) 412-3000
14502 W Meeker Blvd
Location 10/17Sun City West, AZ 85375-5282 · Phone (623) 524-4000
1800 E Florence Blvd
Location 11/17Casa Grande, AZ 85122-5303 · Phone (520) 381-6300
10401 W Thunderbird Blvd
Location 12/17Sun City, AZ 85351-3004 · Phone (623) 832-4000
7575 E Earll Dr
Location 13/17Scottsdale, AZ 85251-6915 · Phone (480) 448-7500
6644 E Baywood Ave
Location 14/17Mesa, AZ 85206-1747 · Phone (480) 321-2000
1625 N Campbell Ave
Location 15/17Tucson, AZ 85719-4330 · Phone (520) 694-0111
2800 E Ajo Way
Location 16/17Tucson, AZ 85713-6204 · Phone (520) 874-2000
1111 E McDowell Rd
Location 17/17Phoenix, AZ 85006-2612 · Phone (602) 839-2000
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