# POUDRE VALLEY MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Other names:** UCHealth GI Lab - Memorial Hospital North, UCHealth Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1992523807
- **Legal business name:** POUDRE VALLEY MEDICAL GROUP, LLC
- **Authorized official:** JANA CONROY (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (719) 365-5543

## Contact information

- **Practice address:** 4050 BRIARGATE PKWY STE A2115, COLORADO SPRINGS, CO 80920-7815
- **Practice address phone:** (719) 365-5543
- **Mailing address:** 2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/30/2024
- **Last updated:** 09/30/2024