Banner Health Physicians Colorado LLC
Organization Active NPI Multi-Specialty Clinic/Center · Berthoud, CO
NPI 1669733291 · NPPES record last updated Apr 17, 2026
Key facts
- NPI
- 1669733291
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- BANNER HEALTH PHYSICIANS COLORADO LLC
- Practice address
- 401 10TH St
Berthoud, CO 80513-1381 - Phone
- (970) 532-4910
- NPI assigned
- May 30, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- BANNER MEDICAL GROUP COLORADO
Authorized official
- Name
- Shiva Birdi
- Title
- Ceo
- Phone
- (602) 747-4000
Practitioners 1
-
David L Bicknell, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
401 10TH St
Berthoud, CO 80513-1381
Mailing address
2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702
Other providers in Berthoud, CO
- Ross W Armour
- Tracey Ashcraft
- Judi Lynn Ashley
- Azure Care LLC
- Vicki Baker
- Keely Beck
- Carmen Beckwith
- Berthoud Drug, LLC
- Berthoud Family Physicians
- Berthoud Physical Therapy LLC
All providers in Berthoud, CO · Multi-Specialty Clinic/Center in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.