NPIMap

Poudre Valley Medical Group, LLC

Organization Active NPI Surgery Physician · Pueblo, CO

NPI 1699562108 · NPPES record last updated Apr 21, 2025

Key facts

NPI
1699562108
Entity type
Organization (NPI type 2)
Primary specialty
Surgery Physician 208600000X
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Practice address
1600 N Grand Ave Ste 540
Pueblo, CO 81003-2757
Phone
(719) 545-8240
Fax
(719) 545-4319
NPI assigned
Apr 21, 2025
Organization subpart
Yes
Parent organization (as reported)
POUDRE VALLEY MEDICAL GROUP, LLC

Authorized official

Name
Jana Conroy
Title
Director of Credentialing
Phone
(719) 545-8240

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Poudre Valley Medical LLC (282 organizations share this tax ID)
Part of
Poudre Valley Medical LLC

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208600000X Yes

Addresses

Primary practice location

1600 N Grand Ave Ste 540
Pueblo, CO 81003-2757

Mailing address

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

Other names

  • UCHealth Medical Group Doing business as
  • Sangre De Cristo Weight Loss Institute Other name

Other providers in Pueblo, CO

All providers in Pueblo, CO · Surgery Physician in Colorado

Sources for this page

Verify at the official NPI Registry.