POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1265054555) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265054555 |
| Entity Type | Organization |
| Organization Name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Practice Address |
6767 29th St Fl 3 Greeley CO 80634-5474 |
| Mailing Address |
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 |
| Practice Telephone | 9702211000 |
| Practice Fax Number | 9706522499 |
| Mailing Telephone | 9702211000 |
| Mailing Fax Number | 9706522499 |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-05-11 |
| 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 - Greeley | 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 |
6767 29TH ST FL 3 |
| City | GREELEY |
| State | CO |
| Zip Code | 80634-5474 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649536723 | Eks Wye Pollock Iv | Internal Medicine | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2012-04-03 |
| 1144833146 | Poudre Valley Medical Group, LLC | Neurological Surgery | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-08-28 |
| 1255944831 | Poudre Valley Medical Group, LLC | Pediatrics | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-08-25 |
| 1598378176 | Poudre Valley Medical Group, LLC | Physical Medicine & Rehabilitation | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-08-25 |
| 1841814613 | Poudre Valley Medical Group, LLC | Preventive Medicine | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-06-08 |
| 1649892662 | Poudre Valley Medical Group, LLC | Psychiatry & Neurology | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-05-13 |
| 1588286678 | Poudre Valley Medical Group, LLC | Internal Medicine | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-05-12 |
| 1235758012 | Poudre Valley Medical Group, LLC | Family Medicine | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-04-13 |
| 1336768480 | Poudre Valley Medical Group, LLC | Otolaryngology | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-04-09 |
| 1750910923 | Poudre Valley Medical Group, LLC | Dermatology | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707843 | Witting Medical, LLC | Pathology | 17 Dos Rios, Greeley, CO 80634 | 2020-07-15 |
| 1730706102 | Heart Centered Counseling | Counselor | 1770 W 25th Street #206, Greeley, CO 80634 | 2020-07-01 |
| 1396374237 | Kidstuff Child and Family Counseling, P.C. | Counselor | 1770 25th Ave., Ste. 102, Greeley, CO 80634 | 2020-04-03 |
| 1164055745 | Stephanie Alexis Balunda | Speech-Language Pathologist | Uchealth Physical Therapy and Rehabilitation Clinic, 6767 West 29th St., Greeley, CO 80634 | 2020-02-21 |
| 1407413727 | Stephen P Street Pllc | Counselor | 4657 W. 20th Street, Unit B, Greeley, CO 80634 | 2019-05-22 |
| 1043797749 | Burt Stewart Dmd Pllc | Clinic/Center | 6937 West 10th Street, Greeley, CO 80634 | 2018-07-25 |
| 1164913885 | Innovations Pediatric Therapy, LLC | Occupational Therapist | 3403 W 7th St Apt A, Greeley, CO 80634 | 2018-05-29 |
| 1003305319 | Austin Michael Lake | Physical Therapist | 4681 W 20th St Unit 202b, Greeley, CO 80634 | 2018-05-02 |
| 1225542004 | Kevin Lichner | Specialist/Technologist | 522 28th Ave, Greeley, CO 80634 | 2017-11-30 |
| 1538683909 | Stacie Jackson | Physician Assistant | 6500 West 29th St Ste 106, Greeley, CO 80634 | 2017-07-27 |
| Find all providers in zip 80634 | ||||
| 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 |
|---|---|---|---|---|
| 1659665453 | Candice Morgan | Internal Medicine | 2510 58th Ave, Greeley, CO 80634-4525 | 2011-06-09 |
| 1386677144 | Michael Sang-hak Kim | Internal Medicine | 1800 15th St Ste 310, Greeley, CO 80631-4562 | 2006-07-07 |
| 1912325556 | Edward Ladyzhenskiy | Internal Medicine | 1800 15th St Ste 310, Greeley, CO 80631-4562 | 2014-04-01 |
| 1114064490 | Lin-wang Dong | Internal Medicine | 1800 15th St, Suite 310, Greeley, CO 80631-4500 | 2007-01-30 |
| 1558378166 | Ahmad H Shihabi | Internal Medicine | 1800 15th St, Suite 310, Greeley, CO 80631-4500 | 2006-08-03 |
| 1346273430 | North Colorado Cardiology, PC | Internal Medicine | 1800 15th St, Suite 310, Greeley, CO 80631-4500 | 2006-07-09 |
| 1205894284 | Arnold Edward Pfahnl | Internal Medicine | 1800 15th St, Suite 310, Greeley, CO 80631-4500 | 2006-05-01 |
| 1730143033 | Paul G Hurst | Internal Medicine | 1800 15th St, Suite 310, Greeley, CO 80631-4500 | 2006-04-13 |
| 1144284456 | Gary A Rath | Internal Medicine | 1800 15th St, Suite 310, Greeley, CO 80631-4500 | 2006-04-13 |
| 1497719835 | Harold L Chapel | Internal Medicine | 1800 15th St, Suite 310, Greeley, CO 80631-4500 | 2006-04-13 |
| Find all providers in GREELEY | ||||
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| 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.