# POUDRE VALLEY MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Other names:** UCHealth Primary Care - Ken Pratt Blvd
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1255918058
- **Legal business name:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Authorized official:** JANA CONROY MBA, RHIA (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (720) 718-8410

## Contact information

- **Practice address:** 601 S MAIN ST, LONGMONT, CO 80501-6427
- **Practice address phone:** (720) 718-8410
- **Practice address fax:** (720) 718-8999
- **Mailing address:** 2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/26/2021
- **Last updated:** 07/12/2024