MEDICARE: POUDRE VALLEY HEALTH CARE,INC

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
1	261QM2500X	Medical Specialty Clinic/Center
2	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891837738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POUDRE VALLEY HEALTH CARE,INC

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	:	1025 PENNOCK PL STE 114
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3250
Country	:	US
Telephone Number	:	970-495-8800
Fax Number	:	970-495-8820

Authorized Official
Title or Position	:	CFO
Name	:	DAVID THOMPSON
Credential	:
Telephone Number	:	970-495-7000

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	03/12/2025

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