Active NPI
Banner Health Physicians Colorado LLC
- Multi-Specialty Clinic/Center
- Greeley, CO
National Provider Identifier
1306114475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- BANNER HEALTH PHYSICIANS COLORADO LLC
- Practice address
- 1800 15TH St Ste 300
Greeley, CO 80631-4562 - Phone
- (970) 392-2344
- NPI assigned
- Dec 5, 2011
- Organization subpart
- Yes
- Parent organization
- BANNER MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dennis Laraway
- Title
- Cfo
- Phone
- (602) 747-4000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Primary |
Addresses
Primary practice location
1800 15TH St Ste 300
Greeley, CO 80631-4562
Mailing address
2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111219000237 | CO | Part B Supplier - Clinic/Group Practice | 8921273038 |
Receives reassigned benefits from 380 practitioners This NPI is an additional NPI on the enrollment Practice locations: Loveland, CO; Yuma, CO; Sterling, CO; Timnath, CO; Wellington, CO; Windsor, CO; Wray, CO; Fort Collins, CO… |
National Provider Directory
National Provider Directory- Part of
- Tiffany Weathers
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323043200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1646697600000",
"number": "1306114475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 N CENTRAL AVE STE 160",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850122702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 15TH ST STE 300",
"city": "GREELEY",
"state": "CO",
"postal_code": "806314562",
"telephone_number": "970-392-2344"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BANNER HEALTH PHYSICIANS COLORADO LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BANNER MEDICAL GROUP",
"enumeration_date": "2011-12-05",
"last_updated": "2022-03-08",
"certification_date": "2022-03-08",
"status": "A",
"authorized_official_last_name": "LARAWAY",
"authorized_official_first_name": "DENNIS",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "602-747-4000"
},
"taxonomies": [
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greeley, CO
- Banner Health Physicians Colorado LLC
- Banner Health Physicians Colorado LLC
- Banner Health Physicians Colorado LLC
- Banner Health Physicians Colorado LLC
- Banner Health Physicians Colorado LLC
- Banner Health Physicians Colorado LLC
- Banner Health Physicians Colorado LLC
- Banner Health Physicians Colorado LLC
- Banner Health Physicians Colorado LLC
- Banner Health Physicians Colorado LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.