NPIMap

Organization Active NPI

Poudre Valley Medical Group, LLC

Doing business as UCHealth Medical Group

  • Plastic and Reconstructive Surgery Physician
  • Pueblo, CO
National Provider Identifier
1396531745
Registry record updated Apr 15, 2025
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
Doing business as
UCHealth Medical Group
Practice address
1600 N Grand Ave Ste 230
Pueblo, CO 81003-2731
Phone
(719) 542-2470
Fax
(719) 542-2465
NPI assigned
Apr 15, 2025
Organization subpart
Yes
Parent organization
POUDRE VALLEY MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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
(719) 542-2470

Specialties & licenses 1

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

Addresses

Primary practice location

1600 N Grand Ave Ste 230
Pueblo, CO 81003-2731

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071

Other names 2

  • UCHealth Medical Group Doing business as
  • UCHealth Plastic and Reconstructive Surgery Clinic - Parkview MOB Other name

National Provider Directory

National Provider Directory
Tax ID family
Poudre Valley Med GR LLC283 organizations share this tax ID, including this one
Part of
Poudre Valley Med GR 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

1600 N Grand Ave
Ste 230
Pueblo, CO 81003
Phone (719) 542-2470

NPI Registry JSON

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

{
    "created_epoch": "1744675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744675200000",
    "number": "1396531745",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N GRAND AVE STE 230",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032731",
            "telephone_number": "719-542-2470",
            "fax_number": "719-542-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "enumeration_date": "2025-04-15",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "719-542-2470"
    },
    "taxonomies": [
        {
            "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"
        },
        {
            "organization_name": "UCHealth Plastic and Reconstructive Surgery Clinic - Parkview MOB",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2025; 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.