Organization
BANNER MOUNTAIN VISTA ORTHOPAEDIC MEDICAL CLINIC
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS DAHLEN (SR VP FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1300 MAIN ST, WINDSOR, CO 80550-5989
(970) 348-0020
(970) 348-0055
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
07/12/2012
Last updated
07/12/2012
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