Healthcare Provider Details

I. General information

NPI: 1144535444
Provider Name (Legal Business Name): POUDRE VALLEY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 PENNOCK PL STE 121
FORT COLLINS CO
80524-3250
US

IV. Provider business mailing address

7901 E LOWRY BLVD MAIL STOP F402
DENVER CO
80230-6507
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID THOMPSON
Title or Position: CFO
Credential:
Phone: 970-495-7000