# 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:** 1497431597
- **Legal business name:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Authorized official:** JANA CONROY (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (719) 364-4120

## Contact information

- **Practice address:** 3843 RIO VISTA DRIVE, SUITE 2200, COLORADO SPRINGS, CO 80917-3381
- **Practice address phone:** (719) 364-4120
- **Practice address fax:** (719) 364-4121
- **Mailing address:** 2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |
| 231H00000X | Audiologist | — | NULL | — |
| 231H00000X | Audiologist | — | — | — |

## Other

- **Enumeration date:** 06/23/2023
- **Last updated:** 07/31/2024