Provider Demographics
NPI:1538584628
Name:BANNER ESTRELLA MEDICAL CENTER
Entity type:Organization
Organization Name:BANNER ESTRELLA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LARAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-747-4000
Mailing Address - Street 1:2901 N CENTRAL AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9301 W. THOMAS RD.
Practice Address - Street 2:BANNER ESTRELLA MEDICAL CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4341
Practice Address - Country:US
Practice Address - Phone:623-327-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANNER HEALTH CORPORATE OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-26
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN135342251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care