National Provider Identifier Database

POUDRE VALLEY MEDICAL GROUP LLC
Vascular Surgery

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.


Contact Information

POUDRE VALLEY MEDICAL GROUP, LLC
1400 E BOULDER ST STE 600
COLORADO SPRINGS, CO80909-5533
Phone: 719-364-8346
Fax: 719-364-8347
Website:
Specialty Taxonomy Code
* Vascular Surgery 2086S0129X
Phlebology 202K00000X

* Indicates primary specialty

NPI Profile & details for POUDRE VALLEY MEDICAL GROUP, LLC

NPI Number 1477168557
Legal business name
LBN
POUDRE VALLEY MEDICAL GROUP, LLC
Authorized official JANA CONROY - (DIRECTOR OF CREDENTIALING)
Entity Organization
Organization subpart Yes
Enumeration date 09/15/2020
Last updated 07/30/2024 - 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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