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DSH030002G Banner – University Medical Center Phoenix (Terminated)
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Main Details
Name
Banner – University Medical Center Phoenix
Subdivision Name
Banner Health Clinic - ENT
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030002G
Medicare Provider Number
030002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2013
Participating Start Date
10/1/2013
Participating Approval Date
7/19/2013
Last Recertification Date
9/9/2020
Termination Date
Termination Reason
4/1/2021
Site closure
Contacts
Authorizing Official
Banner University Medical Center Phoenix
John W. Scherpf, Chief Operating Officer
(602) 839-8504
Primary Contact
Banner University Medical Center Phoenix
Jeff Anderson, Director, Pharmacy Academic
(602) 839-2657
Addresses
Street Address
1441 N 12th St. 2nd Floor
Phoenix, AZ 85006
Billing Address
Banner University Medical Center Phoenix
1111 E McDowell Rd
Phoenix, AZ 85006
Comments
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