Organization Name:  BANNER -- UNIVERSITY MEDICAL GROUP


Practice Location:
2901 N CENTRAL AVE  PHOENIX, AZ 85012 US
Tel: 602-747-4000  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	207K00000X	Physicians Allergy & Immunology
N	207L00000X	Physicians Anesthesiology
N	207N00000X	Physicians Dermatology
N	207P00000X	Physicians Emergency Medicine
N	207T00000X	Physicians Neurological Surgery
N	207U00000X	Physicians Nuclear Medicine
N	207V00000X	Physicians Obstetrics & Gynecology
N	207W00000X	Physicians Ophthalmology
N	207X00000X	Physicians Orthopaedic Surgery
N	207ZP0102X	Physicians Pathology
N	208000000X	Physicians Pediatrics
N	2085R0202X	Physicians Radiology
N	207R00000X	Physicians Internal Medicine
N	261QA1903X	Ambulatory Health Care Facilities Clinic/Center	AZ
Y	207Q00000X	Physicians Family Medicine

Other Provider Identifiers:

Issuer	Number	State	Type
RAIL ROAD MEDICARE	CC6470	AZ	01
	005638	AZ	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin