Organization
BANNER HEALTH PHYSICIANS WEST LLC
Active
Parent organization
BANNER MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP
Authorized official
DR. SHIVA BIRDI (CEO BMG)
(480) 256-3336
Entity
Organization
Contact information
Practice address
2601 N SPRUCE ST, OGALLALA, NE 69153-2465
(308) 284-3645
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
—
—
Other
Enumeration date
04/06/2012
Last updated
04/04/2023
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