# POUDRE VALLEY MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Other names:** UCHealth Pulmonology Clinic - Trinidad, UCHealth Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1861288425
- **Legal business name:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Authorized official:** JANA CONROY (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (719) 845-4243

## Contact information

- **Practice address:** 410 BENEDICTA AVE, TRINIDAD, CO 81082-2005
- **Practice address phone:** (719) 845-4243
- **Practice address fax:** (719) 845-9213
- **Mailing address:** 2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | Yes |
| 207RP1001X | Pulmonary Disease Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/18/2025
- **Last updated:** 04/18/2025