Organization
BANNER HEALTH PHYSICIANS COLORADO LLC
Active
Parent organization
BANNER MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP
Authorized official
DENNIS L LARAWAY (CHIEF FINANCIAL OFFICER)
(602) 747-4000
Entity
Organization
Contact information
Practice address
608 E HARMONY RD STE 101, FORT COLLINS, CO 80525-3210
(970) 821-4702
(970) 744-5305
Mailing address
2901 N CENTRAL AVE, PHOENIX, AZ 85012-2700
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/08/2021
Last updated
09/08/2021
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