National Provider Identifier Database

POUDRE VALLEY MEDICAL GROUP LLC
Cardiovascular Disease

An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.


Contact Information

POUDRE VALLEY MEDICAL GROUP, LLC
1600 N GRAND AVE STE 500
PUEBLO, CO81003-2757
Phone: 719-545-0663
Fax: 719-595-7903
Website:
Specialty Taxonomy Code
* Cardiovascular Disease 207RC0000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X
Vascular Surgery 2086S0129X

* Indicates primary specialty

NPI Profile & details for POUDRE VALLEY MEDICAL GROUP, LLC

NPI Number 1710772819
Legal business name
LBN
POUDRE VALLEY MEDICAL GROUP, LLC
Authorized official JANA CONROY - (DIRECTOR OF CREDENTIALING)
Entity Organization
Organization subpart Yes
Enumeration date 04/10/2025
Last updated 04/10/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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