Healthcare Provider Details

I. General information

NPI: 1003430281
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

1610 PRAIRIE CENTER PKWY STE 2300
BRIGHTON CO
80601-4003
US

IV. Provider business mailing address

1610 PRAIRIE CENTER PKWY STE 2300
BRIGHTON CO
80601-4003
US

V. Phone/Fax

Practice location:
  • Phone: 303-498-2260
  • Fax: 303-489-2236
Mailing address:
  • Phone: 303-498-2260
  • Fax: 303-489-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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