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Organization

BANNER HOSPITAL BASED PHYSICIANS COLORADO 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
2000 CAMPBELL DR, TORRINGTON, WY 82240-1528
(970) 392-2135
(970) 378-3825
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
01/25/2013
Last updated
01/28/2022
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