Organization
BANNER HEALTH PHYSICIANS ALASKA LLC
Active
Parent organization
BANNER MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP
Authorized official
DENNIS DAHLEN (SR VP FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1001 NOBLE ST, FAIRBANKS, AK 99701-4948
(907) 459-3507
(907) 459-3532
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
(602) 747-4000
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/09/2014
Last updated
09/11/2014
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