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	207RR0500X	Rheumatology Physician
2	208600000X	Surgery Physician
3	207VE0102X	Reproductive Endocrinology Physician
4	202D00000X	Integrative Medicine Physician
5	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
6	208VP0000X	Pain Medicine Physician
7	208800000X	Urology Physician
8	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1871115758
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	:	2500 ROCKY MOUNTAIN AVE STE 2200
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9004
Country	:	US
Telephone Number	:	970-203-7050
Fax Number	:	970-203-7055

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	JANA CONROY
Credential	:
Telephone Number	:	970-203-7050

Provider Enumeration Date	:	05/13/2020
Last Update Date	:	10/17/2025

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