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NPI Code Detail

MEDICARE: POUDRE VALLEY MEDICAL GROUP, LLC

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 License Number License Number State
1163WW0000XWound Care Registered Nurse
2207RH0002XHospice and Palliative Medicine (Internal Medicine) Physician
3261Q00000XClinic/Center
4261QE0002XEmergency Care Clinic/Center
5208M00000XHospitalist Physician
6208100000XPhysical Medicine & Rehabilitation Physician
7261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
81041C0700XClinical Social Worker
92084P0800XPsychiatry Physician
10363LN0000XNeonatal Nurse Practitioner
11208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1710593611
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 : 1024 S LEMAY AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-3929
Country : US
Telephone Number : 970-495-8440
Fax Number : 970-495-7644
Authorized Official
Title or Position : DIRECTOR OF CREDENTIALING
Name : JANA CONROY
Credential :
Telephone Number : 970-495-8440
Provider Enumeration Date : 09/17/2020
Last Update Date : 12/08/2025

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Directions to “POUDRE VALLEY MEDICAL GROUP, LLC ” Practice Location

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