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Organization
POUDRE VALLEY MEDICAL GROUP, LLC
Active
Organization
POUDRE VALLEY MEDICAL GROUP, LLC
Active
Parent organization
POUDRE VALLEY MEDICAL GROUP, LLC
Other names
UCHealth Medical Group, UCHealth Primary Care and Sports Medicine Clinic - Lake Plaza
Organization subpart
Yes
Provider details
NPI number
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Authorized official
JANA CONROY (DIRECTOR OF CREDENTIALING)
(719) 365-3600
Entity
Organization
Contact information
Practice address
1220 LAKE PLAZA DR STE 150, COLORADO SPRINGS, CO 80906-3548
(719) 365-3600
(719) 365-3601
Mailing address
2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
NULL
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
NULL
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
04/13/2020
Last updated
06/11/2024
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