Provider Demographics
NPI:1881225639
Name:BANNER SURGERY CENTER - THUNDERBIRD, LLC
Entity Type:Organization
Organization Name:BANNER SURGERY CENTER - THUNDERBIRD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-354-4935
Mailing Address - Street 1:2355 E CAMELBACK RD STE 700
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-9044
Mailing Address - Country:US
Mailing Address - Phone:602-550-0428
Mailing Address - Fax:
Practice Address - Street 1:9301 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3327
Practice Address - Country:US
Practice Address - Phone:602-354-8847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical