Organization
NCMC SPECIALTY CLINIC
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
2000 BOISE AVE, LOVELAND, CO 80538-5006
(970) 820-2409
(970) 810-6965
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
(602) 747-4000
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/26/2017
Last updated
12/22/2021
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