=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326991936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BANNER HEALTH PHYSICIANS COLORADO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2026
-----------------------------------------------------
Last Update Date | 02/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 LADY MOON DR STE C2
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80528-4426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-810-5996
-----------------------------------------------------
Fax | 970-810-5997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 N CENTRAL AVE STE 160
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85012-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-747-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHIVA BIRDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-747-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------