Poudre Valley Medical Group, LLC

NPI #1689445702 in Boulder, Colorado

Provider Information

NPI Number: 1689445702
Entity Type: Organization
Organization Name: Poudre Valley Medical Group, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: POUDRE VALLEY MEDICAL GROUP, LLC
Primary Specialty: Surgery - Vascular Surgery
Enumeration Date: Jan 9, 2024
Last Updated: Jan 23, 2024

Practice Location

Address: 2750 BROADWAY ST STE 2178
City: Boulder
State: Colorado
ZIP Code: 80304-3573
Phone: (970) 624-1800

Authorized Official

Name: JANA CONROY
Title: DIRECTOR OF CREDENTIALING
Phone: (970) 624-1800

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine - Cardiovascular Disease — Cardiovascular Disease	207RC0000X
Surgery - Vascular Surgery — Vascular Surgery	2086S0129X	Primary

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