Organization
BANNER MEDICAL GROUP GREELEY LLC
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
100 S CHERRY AVE, UNIT 1, EATON, CO 80615-8255
(970) 454-1265
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
—
75008360
—
CO
Enumeration date
10/08/2008
Last updated
10/08/2008
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