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NPI Code Detail

MEDICARE: POUDRE INFUSION THERAPY LLC

MEDICARE: POUDRE INFUSION THERAPY 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
1332BP3500XParenteral & Enteral Nutrition Supplies (DME)440000021CO
23336S0011XSpecialty Pharmacy440000021CO
3332BP3500XParenteral & Enteral Nutrition Supplies (DME)440000021
43336H0001XHome Infusion Therapy Pharmacy440000021CO

Other Identifiers

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

General Provider Information

NPI Number : 1912909987
Entity Type Code : Organization
Provider Name (Legal Business Name) : POUDRE INFUSION THERAPY LLC
Provider Business Mailing Address
First Line : 915 CENTRE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-6045
Country : US
Telephone Number : 970-494-2130
Fax Number : 970-494-9815
Provider Business Practice Location Address
First Line : 915 CENTRE AVE
Second Line : SUITE 3
City : FORT COLLINS
State : CO
Zip : 80526-6045
Country : US
Telephone Number : 970-494-2130
Fax Number : 970-494-2131
Authorized Official
Title or Position : PIC
Name : LAUREN N STACKHOUSE
Credential :
Telephone Number : 970-494-2130
Provider Enumeration Date : 08/10/2005
Last Update Date : 05/18/2026

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Directions to “POUDRE INFUSION THERAPY LLC ” Practice Location

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