| Banner Telehealth Llc | |
|
7575 E Earll Dr Ste 101 Scottsdale AZ 85251-6915 | |
| (480) 684-8345 | |
| (480) 412-5477 |
| Full Name | Banner Telehealth Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7575 E Earll Dr Ste 101, Scottsdale, Arizona |
| Authorized Official Name and Position | Dennis Laraway (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Telehealth Llc 2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 Ph: () - | Banner Telehealth Llc 7575 E Earll Dr Ste 101 Scottsdale AZ 85251-6915 Ph: (480) 684-8345 |
| NPI Number | 1396492005 |
|---|---|
| Provider Enumeration Date | 03/03/2022 |
| Last Update Date | 03/03/2022 |
| Medicare PECOS PAC ID | 7113314279 |
|---|---|
| Medicare Enrollment ID | O20220420002128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396492005 | NPI | - | NPPES |
| Provider Name | Kimberly S Noll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215264221 PECOS PAC ID: 2062551856 Enrollment ID: I20091208000579 |
| Provider Name | Stephanie Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033654272 PECOS PAC ID: 1658626270 Enrollment ID: I20180621001982 |
| Provider Name | Felisha M Hudson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811376338 PECOS PAC ID: 5698196046 Enrollment ID: I20200610003401 |
| Provider Name | Parris Watson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144767252 PECOS PAC ID: 0042587693 Enrollment ID: I20200901002702 |
| Provider Name | Margaret Kenan Comford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750335394 PECOS PAC ID: 3274941786 Enrollment ID: I20210422001570 |
| Provider Name | Nicole Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427556240 PECOS PAC ID: 4183015720 Enrollment ID: I20211215002135 |
| Provider Name | Lisa L Mckirchy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881218212 PECOS PAC ID: 1456736982 Enrollment ID: I20220919002754 |
| Provider Name | Jaclyn Ann Grajewski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376106294 PECOS PAC ID: 6305222894 Enrollment ID: I20221006002534 |
| Provider Name | Trenel Levette Loggins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629727581 PECOS PAC ID: 3779948336 Enrollment ID: I20230503003239 |
| Provider Name | Amy Chislock Van Ness |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780247494 PECOS PAC ID: 2961845193 Enrollment ID: I20240205003292 |
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