Organization
BANNER HEALTH PHYSICIANS WEST LLC
Active
Parent organization
BANNER MEDICAL GROUP COLORADO
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP COLORADO
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
4108 LARAMIE ST, CHEYENNE, WY 82001-1969
(970) 493-1292
(970) 493-1210
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
07/26/2022
Last updated
07/26/2022
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