Organization
POUDRE VALLEY MEDICAL GROUP, LLC
Active
Other names
UCHealth Surgical Care - Longs Peak Hospital, UCHealth Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JANA CONROY (CREDENTIALING MANAGER)
(970) 624-4443
Entity
Organization
Contact information
Practice address
1750 E KEN PRATT BLVD FL 3, LONGMONT, CO 80504-5311
(720) 718-3930
(720) 718-0999
Mailing address
1750 E KEN PRATT BLVD FL 3, LONGMONT, CO 80504-5311
(720) 718-3930
(720) 718-0999
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
Other
Enumeration date
09/10/2020
Last updated
01/14/2021
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