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 L LARAWAY (CHIEF LEGAL OFFICER)
(602) 747-4000
Entity
Organization
Contact information
Practice address
2300 GASSER RD, RIVERTON, WY 82501-2204
(307) 347-5810
(307) 347-5808
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
08/03/2020
Last updated
08/03/2020
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