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DSH030122D BANNER GATEWAY MEDICAL CENTER (Active)
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Main Details
Name
BANNER GATEWAY MEDICAL CENTER
Subdivision Name
Banner MD Anderson Outpatient Imaging Center Suite 150
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030122D
Medicare Provider Number
030122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/8/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Banner Gateway Medical Center
Ana Barraza, CFO
(480) 543-2277
Primary Contact
Banner Gateway Medical Center
Tanya Nacy, Pharmacy Director
(480) 543-2190
Addresses
Street Address
2940 E BANNER GATEWAY DRIVE
BANNER MD ANDERSON CANCER CENTER - IMAGING CENTER
SUITE 150
GILBERT, AZ 85234-2176
Billing Address
Banner Health Accounts Payable
PO Box 2977
Phoenix, AZ 85062
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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