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General NPI Number Information
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NPI Number | 1417574393
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Entity Type | Organization
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Legal Business Name | PLATTE VALLEY MEDICAL GROUP LLC
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 1606 PRAIRIE CENTER PKWY STE 210
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City | BRIGHTON
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State | CO
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Zip | 80601-4004
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Country | US
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Telephone | 303-318-2229
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Fax | 720-501-6701
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Provider Business Mailing Address
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Address Line | 1606 PRAIRIE CENTER PKWY STE 210
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City | BRIGHTON
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State | CO
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Zip | 80601-4004
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Country | US
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Telephone | 303-318-2229
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Fax | 720-501-6701
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Authorized Official
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Title or Position | VP FINANCE OPERATIONS
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Name | JON MCDANIEL
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Credential |
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Telephone | 303-272-0231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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