MEDICARE: POUDRE VALLEY HEALTH CARE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PDO31680000097	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154706554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POUDRE VALLEY HEALTH CARE INC

Provider Business Mailing Address
First Line	:	7901 E LOWRY BLVD
Second Line	:	MAIL STOP F402
City	:	DENVER
State	:	CO
Zip	:	80230-6507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4630 SNOW MESA DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8508
Country	:	US
Telephone Number	:	970-237-8140
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DAVID THOMPSON
Credential	:
Telephone Number	:	970-237-8100

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	01/04/2024

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