BANNER MEDICAL GROUP GREELEY LLC (NPI# 1104070333) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104070333 |
| Entity Type | Organization |
| Organization Name | BANNER MEDICAL GROUP GREELEY LLC |
| Practice Address |
5623 W 19th St Greeley CO 80634-2901 |
| Mailing Address |
1441 N 12th St Phoenix AZ 85006-2837 |
| Practice Telephone | 9703539011 |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2010-09-20 |
| Authorized Official Name | DENNIS DAHLEN (SR VP FINANCE) |
| Authorized Official Telephone | 6027474000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 11658541 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972804318 | Banner Medical Group Greeley LLC | Clinic/Center | 2010 16th St, Greeley, CO 80631-5162 | 2010-11-16 |
| 1992018113 | Banner Medical Group Greeley LLC | Clinic/Center | 2001 70th Ave, Suite 110, Greeley, CO 80634-4621 | 2010-07-16 |
| 1679804223 | Banner Medical Group Greeley LLC | Clinic/Center | 1300 Main St, Windsor, CO 80550-5989 | 2010-01-21 |
| 1841441870 | Banner Medical Group Greeley LLC | Clinic/Center | 100 S Cherry Ave, Unit 1, Eaton, CO 80615-8255 | 2008-10-08 |
| 1386817880 | Banner Medical Group Greeley LLC | Clinic/Center | 222 Johnstown Center Dr, Johnstown, CO 80534-9030 | 2008-04-07 |
| Street Address |
5623 W 19TH ST |
| City | GREELEY |
| State | CO |
| Zip Code | 80634-2901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013912930 | Jacqueline S Bearden | Family Medicine | 5623 W 19th St, Greeley, CO 80634-2901 | 2005-06-16 |
| 1750645099 | Banner Health Physicians Colorado LLC | Clinic/Center | 5623 W 19th St, Greeley, CO 80634-2901 | 2012-07-02 |
| 1982800835 | David Carl Puls | Family Medicine | 5623 W 19th St, Greeley, CO 80634-2901 | 2007-06-26 |
| 1417942962 | Westlake Family Physicians, PC | Clinic/Center | 5623 W 19th St, Greeley, CO 80634-2901 | 2005-09-12 |
| 1528063468 | Frank D Morgan | Family Medicine | 5623 W 19th St, Greeley, CO 80634-2901 | 2005-06-16 |
| 1770588618 | Dana Marie Morgan | Family Medicine | 5623 W 19th St, Greeley, CO 80634-2901 | 2005-06-16 |
| 1457356388 | Janis R Mccall | Family Medicine | 5623 W 19th St, Greeley, CO 80634-2901 | 2005-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707843 | Witting Medical, LLC | Pathology | 17 Dos Rios, Greeley, CO 80634 | 2020-07-15 |
| 1730706102 | Heart Centered Counseling | Counselor | 1770 W 25th Street #206, Greeley, CO 80634 | 2020-07-01 |
| 1396374237 | Kidstuff Child and Family Counseling, P.C. | Counselor | 1770 25th Ave., Ste. 102, Greeley, CO 80634 | 2020-04-03 |
| 1164055745 | Stephanie Alexis Balunda | Speech-Language Pathologist | Uchealth Physical Therapy and Rehabilitation Clinic, 6767 West 29th St., Greeley, CO 80634 | 2020-02-21 |
| 1407413727 | Stephen P Street Pllc | Counselor | 4657 W. 20th Street, Unit B, Greeley, CO 80634 | 2019-05-22 |
| 1043797749 | Burt Stewart Dmd Pllc | Clinic/Center | 6937 West 10th Street, Greeley, CO 80634 | 2018-07-25 |
| 1164913885 | Innovations Pediatric Therapy, LLC | Occupational Therapist | 3403 W 7th St Apt A, Greeley, CO 80634 | 2018-05-29 |
| 1003305319 | Austin Michael Lake | Physical Therapist | 4681 W 20th St Unit 202b, Greeley, CO 80634 | 2018-05-02 |
| 1225542004 | Kevin Lichner | Specialist/Technologist | 522 28th Ave, Greeley, CO 80634 | 2017-11-30 |
| 1538683909 | Stacie Jackson | Physician Assistant | 6500 West 29th St Ste 106, Greeley, CO 80634 | 2017-07-27 |
| Find all providers in zip 80634 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346794393 | Banner Health Physicians Colorado LLC | Clinic/Center | 1800 15th St Ste G10, Greeley, CO 80631-4595 | 2016-08-08 |
| 1568840742 | Banner Health Physicians Colorado LLC | Clinic/Center | 5890 W 13th St Ste 104, Greeley, CO 80634-4821 | 2015-05-08 |
| 1487918728 | Banner Health Physicians Colorado LLC | Clinic/Center | 6801 W 20th St Unit 201, Greeley, CO 80634-9640 | 2012-07-02 |
| 1174886758 | Banner Greeley Anesthesia | Clinic/Center | 5890 W 13th St Ste 102, Greeley, CO 80634-4821 | 2012-06-19 |
| 1306114475 | Banner Health Physicians Colorado LLC | Clinic/Center | 1800 15th St Ste 300, Greeley, CO 80631-4562 | 2011-12-05 |
| 1295003366 | Banner Health Physicians Colorado LLC | Clinic/Center | 5890 W 13th St Ste 114, Greeley, CO 80634-4821 | 2011-12-05 |
| 1578840021 | Banner Health Physicians Colorado LLC | Clinic/Center | 5890 W 13th St Ste 106, Greeley, CO 80634-4821 | 2011-11-11 |
| 1447532908 | Banner Greeley Specialists | Clinic/Center | 710 11th Ave, Ste 106, Greeley, CO 80631-6405 | 2011-09-12 |
| 1659907376 | Banner Health Physicians Colorado LLC | Clinic/Center | 2001 70th Ave Ste 110, Greeley, CO 80634-4628 | 2020-03-13 |
| 1255971404 | North Colorado Medical Center | Clinic/Center | 1517 16th Avenue Ct, Greeley, CO 80631-4574 | 2020-01-15 |
| Find all providers in GREELEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.