Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Infusion Therapy |
163WI0500X | |||
Infusion Therapy |
261QI0500X |
| NPI Number | 1184218984 |
| LBN Legal business name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Authorized official | JANA CONROY - (DIRECTOR OF CREDENTIALING) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 02/23/2021 |
| Last updated | 06/11/2024 - More than a year ago |
| Identifiers | n/a |
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