BANNER CANCER CENTER SPECIALISTS LLC (NPI# 1588158448) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588158448 |
| Entity Type | Organization |
| Organization Name | BANNER CANCER CENTER SPECIALISTS LLC |
| Practice Address |
122 E Main St Payson AZ 85541-5574 |
| Mailing Address |
2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 |
| Practice Telephone | 9285964600 |
| Practice Fax Number | 9285964620 |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-06-14 |
| Authorized Official Name | DENNIS LARAWAY (CFO) |
| Authorized Official Telephone | 6027474000 |
| Is Organization Subpart | Y |
| Parent Organization Name | BANNER MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QX0200X |
Clinic/Center Specialization: Oncology |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518253152 | Banner Cancer Center Specialists LLC | Clinic/Center | 2946 E Banner Gateway Drive, Gilbert, AZ 85234 | 2011-06-22 |
| Street Address |
122 E MAIN ST |
| City | PAYSON |
| State | AZ |
| Zip Code | 85541-5574 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841267937 | Leroy Wombold | Surgery | 122 E Main St, Payson, AZ 85541 | 2006-03-07 |
| 1699950485 | Akdhc, Ll | Internal Medicine | 122 E Main St, Akdhc (mountain View Family Clinic), Payson, AZ 85541-0000 | 2007-12-31 |
| 1255488557 | Jennifer Dumbolton | Family Medicine | 122 E Main St, Payson, AZ 85541-5574 | 2007-01-05 |
| 1932156437 | Mountain View Family Medicine PC | Family Medicine | 122 E Main St, Payson, AZ 85541-5646 | 2006-05-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447805130 | Melissa Marie Avery | Registered Nurse | 903 Az-260, Payson, AZ 85541 | 2019-08-08 |
| 1952803710 | Payson Orthodontics | Dentist | 902 S Beeline Hwy, Payson, AZ 85541 | 2018-03-07 |
| 1568844181 | Banner Home Care Arizona | Home Health | 708 E Route 260 Ste A1, Payson, AZ 85541 | 2015-06-19 |
| 1063893626 | Sage Counseling, Inc. | Community/Behavioral Health | 1100 N. Beeline Hwy, Suite F, Payson, AZ 85541 | 2015-06-09 |
| 1053712059 | Garry Gordon | Homeopath | 600 N Beeline Hwy, Payson, AZ 85541 | 2014-09-09 |
| 1821406901 | Monica Nestich | Physical Therapy Assistant | 708 E. State Hwy 260, Payson, AZ 85541 | 2014-08-01 |
| 1841601523 | Megan Fragale Saalfrank | Pharmacist | 401 E. Highway 260, Payson, AZ 85541 | 2014-05-15 |
| 1750791836 | Caring Connections for Special Needs, LLC | Community/Behavioral Health | 600 E. Highway 260, Suite 4 & 5, Payson, AZ 85541 | 2014-04-29 |
| 1164775169 | Kc's Home Health Care LLC of Payson | Home Health | 114 E. Highway 260, Payson, AZ 85541 | 2012-10-16 |
| 1598014458 | Ivan D. Mclaws, Dpm | Podiatrist | 200 East Lone Pine Dr., Payson, AZ 85541 | 2012-09-06 |
| Find all providers in zip 85541 | ||||
| Taxonomy Code | 261QX0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oncology |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment and prescriptive services related to cancerous conditions. Services include chemotherapy infusions and monitoring of implanted chemotherapeutic agents. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073007787 | Southwest Cancer Care LLC | Clinic/Center | 100 E 5th St, Douglas, AZ 85607-2859 | 2018-06-15 |
| 1235656174 | Vincere Surgery Center LLC | Clinic/Center | 7469 E Monte Cristo Ave, Scottsdale, AZ 85260-1618 | 2017-08-22 |
| 1518253152 | Banner Cancer Center Specialists LLC | Clinic/Center | 2946 E Banner Gateway Drive, Gilbert, AZ 85234 | 2011-06-22 |
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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.