Organization
POUDRE VALLEY MEDICAL GROUP, LLC
Active
Other names
UCHealth Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JANA CONROY RHIA (CREDENTIALING MANAGER)
(970) 624-4443
Entity
Organization
Contact information
Practice address
2695 ROCKY MOUNTAIN AVE, SUITE 150, LOVELAND, CO 80538-8702
(970) 624-4420
(970) 624-4459
Mailing address
2695 ROCKY MOUNTAIN AVE, SUITE 150, LOVELAND, CO 80538-8702
(970) 624-4420
(970) 624-4459
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208200000X
Plastic Surgery Physician
—
—
208800000X
Urology Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
225X00000X
Occupational Therapist
—
—
261QE0002X
Emergency Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025926100
—
NE
05
—
130638300
—
WY
01
—
53D0519664
CLIA PVMG CHEYENNE MEDICAL SPECIALISTS
WY
05
—
674844
—
AZ
05
—
69906874
—
CO
Enumeration date
06/15/2010
Last updated
11/19/2019
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