NPIMap

Organization Active NPI

Banner Greeley Specialists

  • Multi-Specialty Clinic/Center
  • Greeley, CO
National Provider Identifier
1649579673
Registry record updated Apr 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BANNER GREELEY SPECIALISTS
Practice address
2410 W 16TH St
Greeley, CO 80634-6004
Phone
(970) 352-6353
Fax
(970) 356-2264
NPI assigned
Mar 16, 2011
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2011

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

Authorized official

Name
Dennis E 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

2410 W 16TH St
Greeley, CO 80634-6004

Mailing address

1441 N 12TH St
Phoenix, AZ 85006-2837

Other identifiers 1

IdentifierTypeStateIssuer
06600379MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Banner Greeley Specialists14 organizations share this tax ID, including this one
Part of
M E Lee MD

Other organizations with this tax ID 13

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

View all 13

Locations

2410 W 16th St
Greeley, CO 80634
Phone (970) 352-6353

NPI Registry JSON

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1649579673",
    "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": "2410 W 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346004",
            "telephone_number": "970-352-6353",
            "fax_number": "970-356-2264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER GREELEY SPECIALISTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2011-03-16",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "E",
        "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": "06600379",
            "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 Apr 19, 2011; 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.