Provider Demographics
NPI:1639877939
Name:BANNER HEALTH PHYSICIANS COLORADO LLC
Entity Type:Organization
Organization Name:BANNER HEALTH PHYSICIANS COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:KARSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-768-3596
Mailing Address - Street 1:2901 N CENTRAL AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 70TH AVE STE 221
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4628
Practice Address - Country:US
Practice Address - Phone:970-810-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANNER HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)