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Organization

NOCO NEWCO, LLC

Active
Parent organization
BANNER MEDICAL GROUP COLORADO
Organization subpart
Yes

Provider details

NPI number
Legal business name
BANNER MEDICAL GROUP COLORADO
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization

Contact information

Practice address
4700 LADY MOON DR, FORT COLLINS, CO 80528-4426
(970) 821-4500
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
12/19/2018
Last updated
12/19/2018
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