Organization
FAMILY CARE CLINIC
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
MATTHEW COX (SR VP FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
102 HAYS AVE, STERLING, CO 80751-2866
(970) 521-3223
(970) 521-3266
Mailing address
2901 N CENTRAL AVE, SUITE 160, PHOENIX, AZ 85012
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
063405
MEDICARE PTAN
CO
Enumeration date
11/21/2014
Last updated
07/26/2017
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