Organization Name: | BANNER HEALTH PHYSICIANS COLORADO LLC |
NPI Number: | 1669733291 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DENNIS DAHLEN (SR VP FINANCE) |
Mailing Address: | 401 10th St Berthoud |
State: | CO US |
Postal Code: | 805131381 |
Phone Number: | 9705324910 |
Fax Number: | |
NPI Enumeration Date: | 05/30/2012 |
NPI Last Update Date: | 07/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |