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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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1992335061
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 : 970-624-4443
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S LEMAY AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-4262
Country : US
Telephone Number : 970-495-8780
Fax Number : 970-495-8799
Authorized Official
Title or Position : MANAGER CREDENTIALING
Name : JANA CONROY
Credential : RHIA
Telephone Number : 970-624-4443
Provider Enumeration Date : 01/17/2020
Last Update Date : 01/17/2020

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

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