MEDICARE: POUDRE VALLEY MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207X00000X	Orthopaedic Surgery Physician
2	207RG0100X	Gastroenterology Physician
3	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1053276261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POUDRE VALLEY MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE STE 150
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9071
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9051 SSG CHRIS FALKEL DRIVE
Second Line	:	SUITE 200
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-3192
Country	:	US
Telephone Number	:	720-516-0600
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	JANA CONROY
Credential	:
Telephone Number	:	720-516-0600

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	04/13/2026

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