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Contact Information

POUDRE VALLEY MEDICAL GROUP, LLC
405 W 15TH ST STE 210
PUEBLO, CO81003-2743
 Phone: 719-584-7300
 Fax: 719-595-7059
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Wound Care

163WW0000X
Indicates primary specialty

NPI Profile & details for POUDRE VALLEY MEDICAL GROUP, LLC

NPI # 1144016700
LBN Legal business name POUDRE VALLEY MEDICAL GROUP, LLC
Authorized official JANA CONROY - (DIRECTOR OF CREDENTIALING)
Entity Organization
Organization subpart 1 Yes
Enumeration date 04/18/2025
Last updated 04/18/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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