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General NPI Number Information
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NPI Number | 1417993916
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Entity Type | Organization
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Legal Business Name | POUDRE VALLEY INTERNISTS PC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 05/01/2009
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Provider Practice Location Address
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Address Line | 4674 SNOW MESA DR STE 100
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City | FORT COLLINS
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State | CO
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Zip | 80528-8615
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Country | US
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Telephone | 970-482-3712
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Fax | 970-482-4057
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Provider Business Mailing Address
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Address Line | 4674 SNOW MESA DR SUITE 100
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City | FORT COLLINS
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State | CO
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Zip | 80528-8615
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Country | US
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Telephone | 970-482-3712
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Fax | 970-482-4057
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MELISSA MCCANN-STOECKLE
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Credential |
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Telephone | 970-482-3712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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