Organization
NCMC SPECIALTY CLINIC
Active
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
2601 N SPRUCE ST, OGALLALA, NE 69153-2465
(970) 392-0900
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83634525
—
CO
Enumeration date
11/10/2011
Last updated
12/22/2021
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