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NPI Code Detail

MEDICARE: POUDRE VALLEY MEDICAL GROUP, LLC

MEDICARE: POUDRE VALLEY MEDICAL GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RP1001XPulmonary Disease Physician
2208VP0000XPain Medicine Physician
3207RC0000XCardiovascular Disease Physician

General Provider Information

NPI Number : 1518465137
Entity Type Code : Organization
Provider Name (Legal Business Name) : POUDRE VALLEY MEDICAL GROUP, LLC
Provider Business Mailing Address
First Line : 2695 ROCKY MOUNTAIN AVE STE 150
Second Line :
City : LOVELAND
State : CO
Zip : 80538-9071
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1100 CENTRAL PARK DR STE 1050
Second Line :
City : STEAMBOAT SPRINGS
State : CO
Zip : 80487-8818
Country : US
Telephone Number : 970-870-1035
Fax Number : 970-870-1036
Authorized Official
Title or Position : DIRECTOR OF CREDENTIALING
Name : JANA CONROY
Credential : MBA, RHIA
Telephone Number : 970-870-1035
Provider Enumeration Date : 01/29/2018
Last Update Date : 08/01/2024

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Directions to “POUDRE VALLEY MEDICAL GROUP, LLC ” Practice Location

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