NPIMap

Organization Active NPI

MMC Specialty Clinic

  • Multi-Specialty Clinic/Center
  • Loveland, CO
National Provider Identifier
1194753780
Registry record updated Oct 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MMC SPECIALTY CLINIC
Practice address
1900 Boise Ave Ste 210
Loveland, CO 80538-5004
Phone
(970) 635-4059
NPI assigned
Jun 30, 2006
Last updated
Oct 21, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 21, 2007

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

Authorized official

Name
Dennis Dahlen
Title
Sr Vice President
Phone
(602) 747-4000

Specialties & licenses 1

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

Addresses

Primary practice location

1900 Boise Ave Ste 210
Loveland, CO 80538-5004

Mailing address

1441 N 12TH St
Phoenix, AZ 85006-2837

Other identifiers 1

IdentifierTypeStateIssuer
64803031MedicaidCO

National Provider Directory

National Provider Directory
Part of
Big Horn Family Med

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Banner Health

    dba Banner Hospice of Northern Colorado

    • Community Based Hospice Care Agency
    • Greeley, CO
    • NPI 1407409964

    Member Of

    NPD member

Locations

1900 Boise Ave
Loveland, CO 80538
Phone (970) 635-4189

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192924800000",
    "number": "1194753780",
    "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": "1900 BOISE AVE STE 210",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805385004",
            "telephone_number": "970-635-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMC SPECIALTY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-10-21",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "SR VICE PRESIDENT",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64803031",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2007; 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.