Organization
POUDRE VALLEY MEDICAL GROUP, LLC
Active
Parent organization
POUDRE VALLEY MEDICAL GROUP, LLC
Other names
UCHealth Breast Surgical Clinic - Eastview, UCHealth Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Authorized official
JANA CONROY (DIRECTOR OF CREDENTIALING)
(719) 477-0211
Entity
Organization
Contact information
Practice address
3843 RIO VISTA DRIVE, SUITE 2600, COLORADO SPRINGS, CO 80917-3379
(719) 477-0211
(719) 477-0501
Mailing address
2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
06/23/2023
Last updated
08/09/2024
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