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General NPI Number Information
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NPI Number | 1366763260
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Entity Type | Organization
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Legal Business Name | POUDRE VALLEY MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 2695 ROCKY MOUNTAIN AVE SUITE 150
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City | LOVELAND
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State | CO
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Zip | 80538-8702
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Country | US
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Telephone | 970-624-4420
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Fax | 970-624-4459
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Provider Business Mailing Address
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Address Line | 2695 ROCKY MOUNTAIN AVE SUITE 150
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City | LOVELAND
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State | CO
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Zip | 80538-8702
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Country | US
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Telephone | 970-624-4420
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Fax | 970-624-4459
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JANA CONROY
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Credential | RHIA
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Telephone | 970-624-4443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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Taxonomy #7
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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Taxonomy #8
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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