| Organization Name: | BANNER PROFESSIONAL SERVICES |
| NPI Number: | 1427370873 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DENNIS DAHLEN (SR VP FINANCE) |
| Mailing Address: | 400 S 15th St Worland |
| State: | WY US |
| Postal Code: | 824013531 |
| Phone Number: | 3073473221 |
| Fax Number: | |
| NPI Enumeration Date: | 02/25/2010 |
| NPI Last Update Date: | 02/25/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |