Banner Health Clinical Connectivity

Office Registration

Please enter the Group information below. For your group's main facility, please enter the Banner Health facility in which your Sponsoring Physician has admitting privileges.

Office Group Information

Group Name

Address

Suite / P.O. Box

City

State

Zip Code

Phone Number

Phone Extension

Primary Fax Number

Main Banner Health Facility

Check if no EHR

Enter your EHR *