POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1063031680) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063031680 |
| Entity Type | Organization |
| Organization Name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Practice Address |
5050 Powderhouse Rd Cheyenne WY 82009-4800 |
| Mailing Address |
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 |
| Practice Telephone | 3076341311 |
| Practice Fax Number | 9702976886 |
| Mailing Telephone | 3076341311 |
| Mailing Fax Number | 9702976886 |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2020-04-14 |
| Authorized Official Name | JANA CONROY (CREDENTIALING MANAGER) |
| Authorized Official Telephone | 9706244443 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| UCHealth Heart and Vascular Clinic - Cheyenne | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350476 | Poudre Valley Medical Group, LLC | Urology | 2315 E Harmony Rd Ste 140, Fort Collins, CO 80528-8620 | 2020-09-15 |
| 1699389353 | Poudre Valley Medical Group, LLC | Internal Medicine | 5818 N Nevada Ave, Suite 225, Colorado Springs, CO 80918 | 2020-09-01 |
| 1700490455 | Poudre Valley Medical Group, LLC | Radiology | 4080 Briargate Parkway, Colorado Springs, CO 80920 | 2020-09-01 |
| 1134732209 | Poudre Valley Medical Group, LLC | Physical Medicine & Rehabilitation | 5818 N Nevada Avenue, Suite 225, Colorado Springs, CO 80918 | 2020-08-28 |
| 1104439322 | Poudre Valley Medical Group, LLC | Radiology | 525 Bob Peters Grv Ste 100, Colorado Springs, CO 80909-4533 | 2020-08-27 |
| 1932712155 | Poudre Valley Medical Group, LLC | Internal Medicine | 940 Central Park Dr Ste 290, Steamboat Springs, CO 80487-8853 | 2020-08-27 |
| 1033722376 | Poudre Valley Medical Group, LLC | Family Medicine | 15854 Jackson Creek Pkwy Unit 120, Monument, CO 80132-8663 | 2020-08-26 |
| 1285247866 | Poudre Valley Medical Group, LLC | Physical Therapist | 6767 29th St Fl 1, Greeley, CO 80634-5474 | 2020-08-25 |
| 1932711868 | Poudre Valley Medical Group, LLC | Obstetrics & Gynecology | 100 Cook St Ste 210, Denver, CO 80206-5328 | 2020-08-21 |
| 1619586187 | Poudre Valley Medical Group, LLC | Urology | 175 S Union Blvd Ste 315, Colorado Springs, CO 80910-3126 | 2020-07-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Poudre Valley Medical Group, LLC | 2695 Rocky Mountain Ave., Suite 110, Loveland, CO 80538 |
| Street Address |
5050 POWDERHOUSE RD |
| City | CHEYENNE |
| State | WY |
| Zip Code | 82009-4800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316920549 | Reed Clifton Shafer | Psychiatry & Neurology | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2005-11-22 |
| 1225641442 | Poudre Valley Medical Group, LLC | Internal Medicine | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2020-08-27 |
| 1174136394 | Poudre Valley Medical Group, LLC | Internal Medicine | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2020-08-27 |
| 1013520345 | Poudre Valley Medical Group, LLC | Family Medicine | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2020-08-26 |
| 1346864790 | Poudre Valley Medical Group, LLC | Pain Medicine | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2020-06-02 |
| 1952923971 | Poudre Valley Medical Group, LLC | Psychiatry & Neurology | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2020-05-13 |
| 1518586114 | Poudre Valley Medical Group, LLC | Internal Medicine | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2020-04-14 |
| 1255771259 | Megan Marie Auer | Registered Nurse | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2013-07-05 |
| 1710110457 | Ambrish M Patel | Physician Assistant | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2009-08-28 |
| 1972701381 | Wyoming Orthopedic and Sports Medicine, LLC | Orthopaedic Surgery | 5050 Powderhouse Rd, Cheyenne, WY 82009-4800 | 2007-07-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659840841 | King & Associates LLC | Private Vehicle | 2232 Dell Range Blvd 245 #3083 Cheyenne, Cheyenne, WY 82009 | 2018-11-16 |
| 1710495700 | Wyoming Endoscopy Center LLC | Clinic/Center | 7220 Comons Circle, Cheyenne, WY 82009 | 2018-01-12 |
| 1912442682 | Lindsey Thurmes Mccoy | Dietitian, Registered | 2232 Dell Range Blvd Ste 282, Cheyenne, WY 82009 | 2017-01-04 |
| 1306380696 | Alexandra Gill | Social Worker | 3304 East 1-80 Service Rd., Cheyenne, WY 82009 | 2016-12-06 |
| 1104213859 | Jennifer Schwartz | Specialist | 2601 Plain View Rd, Cheyenne, WY 82009 | 2015-04-21 |
| 1861830465 | Tyler Boyd | Dentist | 7209 Commons Cir Unit A, Cheyenne, WY 82009 | 2013-06-05 |
| 1639513351 | Gene E Darnell | Pharmacist | 3702 Del Range Blvd, Cheyenne, WY 82009 | 2013-04-24 |
| 1376891952 | Robert R Kanard | Internal Medicine | 714 Edward Dr, Cheyenne, WY 82009 | 2012-08-29 |
| 1639443336 | Jennifer Alam | Case Manager/Care Coordinator | 3304 E. I80 Service Rd, Cheyenne, WY 82009 | 2012-02-28 |
| 1376815357 | Christina Kay Brown | Licensed Practical Nurse | 3304 E I80 Service Rd, Cheyenne, WY 82009 | 2012-02-06 |
| Find all providers in zip 82009 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164524823 | John Edward Glode | Internal Medicine | 1200 E 20th St Ste A, Cheyenne, WY 82001-3979 | 2006-09-02 |
| 1629019351 | Larry J Hattel | Internal Medicine | 3235 Sparks Rd, Suite 200, Cheyenne, WY 82001-6158 | 2006-06-10 |
| 1831487966 | Mehdi Gheshlaghi | Internal Medicine | 2301 House Ave Ste 301, Cheyenne, WY 82001-3178 | 2011-07-11 |
| 1538451539 | Ronald Chin | Internal Medicine | 2301 House Ave Ste 301, Cheyenne, WY 82001-3178 | 2011-05-09 |
| 1003060542 | Cheyenne Cardiovascular Consultants, LLC | Internal Medicine | 2301 House Ave, Suite 301, Cheyenne, WY 82001-3176 | 2008-11-11 |
| 1720296940 | William Joseph Nienaber | Internal Medicine | 2301 House Ave, Suite 301, Cheyenne, WY 82001-3176 | 2007-05-20 |
| 1336188150 | Michael B Higginbotham | Internal Medicine | 2301 House Ave, Cheyenne, WY 82001-3176 | 2006-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982223848 | Physician Group of Utah Inc | Internal Medicine | 1577 Dewar Dr Ste 8, Rock Springs, WY 82901-5716 | 2020-04-10 |
| 1255719407 | University of Utah Adult Services | Internal Medicine | 1208 Hilltop Dr Ste 102, Rock Springs, WY 82901-5858 | 2015-05-08 |
| 1124384797 | Mansour Eltaher Khaddr | Internal Medicine | 1453a Dewar Dr, Rock Springs, WY 82901-5812 | 2012-04-08 |
| 1376686329 | Joseph Ramon Garcia | Internal Medicine | 1333 W 5th St, Ste 103, Sheridan, WY 82801-2752 | 2007-02-15 |
| 1043315872 | Laurence William Vale Deboer | Internal Medicine | 430 Medical Arts Ct., Gillette, WY 82716 | 2006-09-14 |
| 1649387176 | Gerald Dorros | Internal Medicine | 1120 S Thunder Rd, Wilson, WY 83014 | 2006-08-23 |
| 1619903705 | Michael W. Brennan | Internal Medicine | 1333 West 5th St, Ste 103, Sheridan, WY 82801-2752 | 2006-06-23 |
| 1891748703 | John William Pickrell | Internal Medicine | 1230 E 1st St, Casper, WY 82601-2704 | 2006-05-19 |
| 1821041740 | Michel W Skaf | Internal Medicine | 428s Durbin St 104, Casper, WY 82601-2818 | 2006-05-19 |
| 1801848593 | Nicholas J Stamato | Internal Medicine | 501 S Burma Ave Ste 3500, Gillette, WY 82716-3426 | 2006-05-17 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on POUDRE VALLEY MEDICAL GROUP, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.