Organization
MMC SPECIALTY CLINIC
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS DAHLEN (SR VICE PRESIDENT)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1900 BOISE AVE STE 210, LOVELAND, CO 80538-5004
(970) 635-4059
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
—
64803031
—
CO
Enumeration date
06/30/2006
Last updated
10/21/2007
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