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Poudre Valley Medical Group, LLC

Organization Active NPI Family Medicine Physician · Colorado Springs, CO

NPI 1750041844 · NPPES record last updated Aug 8, 2024

Key facts

NPI
1750041844
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Practice address
2685 Dublin Blvd
Colorado Springs, CO 80918-1358
Phone
(719) 592-9890
Fax
(719) 264-7908
NPI assigned
Dec 30, 2021
Organization subpart
Yes
Parent organization (as reported)
POUDRE VALLEY MEDICAL GROUP, LLC

Authorized official

Name
Jana Conroy
Title
Director of Credentialing
Phone
(719) 592-9890

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
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

2685 Dublin Blvd
Colorado Springs, CO 80918-1358

Mailing address

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

Other names

  • UCHealth Medical group Doing business as
  • UCHealth Primary Care - Dublin Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 8, 2024.

{
    "created_epoch": "1640822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1750041844",
    "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": "2685 DUBLIN BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809181358",
            "telephone_number": "719-592-9890",
            "fax_number": "719-264-7908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "enumeration_date": "2021-12-30",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "719-592-9890"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCHealth Medical group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCHealth Primary Care - Dublin",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Colorado Springs, CO

All providers in Colorado Springs, CO · Family Medicine Physician in Colorado

Sources for this page

Verify at the official NPI Registry.