Organization
BIG THOMPSON MEDICAL GROUP INC.
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS E DAHLEN (SR VP)
(602) 747-4000
Entity
Organization
Contact information
Practice address
2923 GINNALA DR, LOVELAND, CO 80538-2702
(970) 669-6660
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04117040
—
CO
Enumeration date
04/21/2011
Last updated
04/27/2011
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