Organization
BANNER HEALTH
Active
Other names
North Colorado Familly Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS LARAWAY JR. (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1600 23RD AVE, GREELEY, CO 80634-6070
(970) 356-2424
(970) 346-2828
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04021291
—
CO
Enumeration date
10/24/2005
Last updated
01/13/2022
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