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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
12083X0100XOccupational Medicine Physician
2261QU0200XUrgent Care Clinic/Center
3207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1811500168
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 : 303-265-3360
Fax Number : 303-265-3361
Provider Business Practice Location Address
First Line : 8155 PINEY RIVER AVE STE 100
Second Line :
City : LITTLETON
State : CO
Zip : 80125-8729
Country : US
Telephone Number : 303-265-3360
Fax Number : 303-265-3361
Authorized Official
Title or Position : DIRECTOR OF CREDENTIALING
Name : JANA CONROY
Credential :
Telephone Number : 303-265-3360
Provider Enumeration Date : 08/26/2020
Last Update Date : 08/09/2024

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

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