NPIMap

Organization Active NPI

Poudre Valley Medical Group, LLC

  • Plastic and Reconstructive Surgery Physician
  • Denver, CO
National Provider Identifier
1205445772
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Practice address
100 Cook St Ste 306
Denver, CO 80206-5339
Phone
(720) 516-9405
Fax
(720) 516-9433
NPI assigned
Jul 30, 2020
Organization subpart
Yes
Parent organization
POUDRE VALLEY MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jana Conroy
Title
Director of Credentialing
Phone
(720) 516-9405

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0122X Primary

Addresses

Primary practice location

100 Cook St Ste 306
Denver, CO 80206-5339

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (720) 516-9405

Other names 1

  • UCHealth Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Poudre Valley Medical LLC282 organizations share this tax ID, including this one
Part of
Poudre Valley Medical LLC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

100 Cook St
Ste 306
Denver, CO 80206
Phone (720) 516-9405

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1205445772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "720-516-9405",
            "fax_number": "720-516-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COOK ST STE 306",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802065339",
            "telephone_number": "720-516-9405",
            "fax_number": "720-516-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "enumeration_date": "2020-07-30",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "720-516-9405"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCHealth Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.