# 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
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1134741242
- **Legal business name:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Authorized official:** JANA CONROY (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (719) 365-5134

## Contact information

- **Practice address:** 525 BOB PETERS GRV STE 302, COLORADO SPRINGS, CO 80909-4533
- **Practice address phone:** (719) 365-5134
- **Practice address fax:** (719) 365-8060
- **Mailing address:** 2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
- **Mailing address phone:** (719) 365-5134
- **Mailing address fax:** (719) 365-8060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | Yes |
| 207RP1001X | Pulmonary Disease Physician | — | — | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 05/12/2020
- **Last updated:** 06/06/2024