Poudre Valley Medical Group, LLC

NPI #1952173981 in Gillette, Wyoming

Provider Information

NPI Number: 1952173981
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: Oct 24, 2023
Last Updated: Oct 24, 2023

Practice Location

Address: 501 S BURMA AVE
City: Gillette
State: Wyoming
ZIP Code: 82716-3426
Phone: (970) 221-1000

Authorized Official

Name: JANA CONROY
Title: DIRECTOR OF CREDENTIALING
Phone: (970) 221-1000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Surgery	208600000X
Internal Medicine - Cardiovascular Disease — Cardiovascular Disease	207RC0000X
Surgery - Vascular Surgery — Vascular Surgery	2086S0129X	Primary

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