# PVHS-ICM HEALTH AND WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Woodward
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023562030
- **Authorized official:** DR. JAMES SPROWELL MD (MD)
- **Authorized official phone:** (970) 495-6201

## Contact information

- **Practice address:** 3702 AUTOMATION WAY, SUITE 103, FORT COLLINS, CO 80525-5737
- **Practice address phone:** (970) 495-6201
- **Mailing address:** 3702 AUTOMATION WAY, SUITE 103, FORT COLLINS, CO 80525-5737
- **Mailing address phone:** (970) 495-6201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/08/2016
- **Last updated:** 08/08/2016