Healthcare Provider Details

I. General information

NPI: 1356965529
Provider Name (Legal Business Name): PLATTE VALLEY MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 PRAIRIE CENTER PKWY STE 270
BRIGHTON CO
80601-4005
US

IV. Provider business mailing address

1606 PRAIRIE CENTER PKWY STE 270
BRIGHTON CO
80601-4005
US

V. Phone/Fax

Practice location:
  • Phone: 303-498-2200
  • Fax: 303-498-2229
Mailing address:
  • Phone: 303-498-2200
  • Fax: 303-498-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON MCDANIEL
Title or Position: VP FINANCE
Credential:
Phone: 303-272-0231