# POUDRE VALLEY MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Other names:** UCHealth Medical Group, UCHealth Gastroenterology Clinic - County Line
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1083365613
- **Legal business name:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Authorized official:** JANA CONROY (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (720) 516-9089

## Contact information

- **Practice address:** 206 W COUNTY LINE RD STE 210, HIGHLANDS RANCH, CO 80129-2320
- **Practice address phone:** (720) 516-9089
- **Practice address fax:** (720) 516-9090
- **Mailing address:** 2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/14/2022
- **Last updated:** 06/11/2024