# 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:** 1871342451
- **Legal business name:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Authorized official:** JANA CONROY (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (970) 493-5334

## Contact information

- **Practice address:** 4601 S MASON ST, FORT COLLINS, CO 80525-3740
- **Practice address phone:** (970) 493-5334
- **Practice address fax:** (970) 493-5334
- **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 |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 231H00000X | Audiologist | — | NULL | — |
| 231H00000X | Audiologist | — | — | — |

## Other

- **Enumeration date:** 05/15/2024
- **Last updated:** 06/18/2024