Organization
BANNER FORT COLLINS PCP LLC
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
SHIVA BIRDI (CEO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1625 FOXTRAIL DR STE 190, LOVELAND, CO 80538-9089
(970) 500-2244
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
05/09/2025
Last updated
07/30/2025
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