Organization
BANNER MEDICAL GROUP GREELEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS DAHLEN (SR VP FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
5623 W 19TH ST, GREELEY, CO 80634-2901
(970) 353-9011
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11658541
—
CO
Enumeration date
11/14/2008
Last updated
09/20/2010
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