# BANNER CANCER CENTER SPECIALISTS COLORADO LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BANNER MEDICAL GROUP COLORADO
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1932682077
- **Legal business name:** BANNER MEDICAL GROUP COLORADO
- **Authorized official:** DENNIS LARAWAY (CFO)
- **Authorized official phone:** (602) 747-4000

## Contact information

- **Practice address:** 2050 BOISE AVE UNIT B, LOVELAND, CO 80538-5036
- **Practice address phone:** (970) 810-6680
- **Practice address fax:** (970) 810-6610
- **Mailing address:** 2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0200X | Oncology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/14/2018
- **Last updated:** 09/14/2018