# 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:** 1205458221
- **Legal business name:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Authorized official:** JANA CONROY (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (970) 482-4373

## Contact information

- **Practice address:** 2315 E HARMONY RD STE 110, FORT COLLINS, CO 80528-8623
- **Practice address phone:** (970) 482-4373
- **Practice address fax:** (970) 484-5682
- **Mailing address:** 2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
- **Mailing address phone:** (970) 482-4373
- **Mailing address fax:** (970) 484-5682

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |

## Other

- **Enumeration date:** 05/13/2020
- **Last updated:** 06/19/2024