Organization
BANNER HEALTH PHYSICIANS COLORADO LLC
Active
Parent organization
BANNER MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
900 LINCOLN AVE, GRANT, NE 69140-3095
(308) 352-7200
(308) 352-7299
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
11/05/2013
Last updated
03/03/2022
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