NPIMap

Organization Active NPI

Banner Fort Collins Medical Center

  • Clinical Medical Laboratory
  • Fort Collins, CO
National Provider Identifier
1538688239
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
BANNER FORT COLLINS MEDICAL CENTER
Practice address
4700 Lady Moon Dr
Fort Collins, CO 80528-4426
Phone
(970) 821-4000
Fax
(970) 821-4501
NPI assigned
Sep 13, 2017
Last updated
Apr 16, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

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

Authorized official

Name
Shiva Birdi
Title
Ceo
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

4700 Lady Moon Dr
Fort Collins, CO 80528-4426

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2084806Banner Health Dba Banner Fort Collins Medical Ctr4700 Lady Moon Dr, Fort Collins, CO 80528AccreditationMay 24, 2028
06D2260751Banner Ft Collins Medical Center-Pulmonary4700 Lady Moon Drive, Fort Collins, CO 80528Certificate of waiverMay 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Custer Comm Hosp Rad28 organizations share this tax ID, including this one
Part of
Custer Comm Hosp Rad

Other organizations with this tax ID 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776297600000",
    "number": "1538688239",
    "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": "4700 LADY MOON DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805284426",
            "telephone_number": "970-821-4000",
            "fax_number": "970-821-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER FORT COLLINS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2017-09-13",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A",
        "authorized_official_last_name": "BIRDI",
        "authorized_official_first_name": "SHIVA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.