Healthcare Provider Details

I. General information

NPI: 1730492612
Provider Name (Legal Business Name): BANNER ONCOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 BOISE AVE SUITE B
LOVELAND CO
80538-5036
US

IV. Provider business mailing address

2050 BOISE AVE B
LOVELAND CO
80538-5036
US

V. Phone/Fax

Practice location:
  • Phone: 970-679-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNIS E DAHLEN
Title or Position: SR VP FINANCE
Credential:
Phone: 602-747-4000