NPIMap

Organization Active NPI

Banner Medical Group Greeley LLC

  • Multi-Specialty Clinic/Center
  • Greeley, CO
National Provider Identifier
1104070333
Registry record updated Sep 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BANNER MEDICAL GROUP GREELEY LLC
Practice address
5623 W 19TH St
Greeley, CO 80634-2901
Phone
(970) 353-9011
NPI assigned
Nov 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dennis Dahlen
Title
Sr VP Finance
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

5623 W 19TH St
Greeley, CO 80634-2901

Mailing address

1441 N 12TH St
Phoenix, AZ 85006-2837

Other identifiers 1

IdentifierTypeStateIssuer
11658541MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Banner Medical Group Greeley LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284940800000",
    "number": "1104070333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 N 12TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5623 W 19TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806342901",
            "telephone_number": "970-353-9011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER MEDICAL GROUP GREELEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2010-09-20",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "SR VP FINANCE",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11658541",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.