Organization
POUDRE VALLEY INTERNISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA MCCANN-STOECKLE (BILLING MANAGER)
(970) 482-3712
Entity
Organization
Contact information
Practice address
4674 SNOW MESA DR, STE 100, FORT COLLINS, CO 80528-8615
(970) 482-3712
(970) 482-4057
Mailing address
4674 SNOW MESA DR, SUITE 100, FORT COLLINS, CO 80528-8615
(970) 482-3712
(970) 482-4057
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05675839
—
CO
01
—
06D0911568
CLIA
CO
05
—
10025031400
—
NE
05
—
117631500
—
WY
Enumeration date
06/22/2006
Last updated
05/01/2009
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