POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1336768480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336768480 |
| 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 | 9706522801 |
| Practice Fax Number | 9706522827 |
| Mailing Telephone | 9706522801 |
| Mailing Fax Number | 9706522827 |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2020-04-09 |
| 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 | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| UCHealth Ear, Nose and Throat 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 |
| 1265054555 | Poudre Valley Medical Group, LLC | Internal Medicine | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-05-11 |
| 1235758012 | Poudre Valley Medical Group, LLC | Family Medicine | 6767 29th St Fl 3, Greeley, CO 80634-5474 | 2020-04-13 |
| 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 | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053423186 | North Colorado Ear Nose & Throat | Otolaryngology | 2528 16th St, Greeley, CO 80634-4955 | 2006-08-31 |
| 1659338812 | James H Peterson | Otolaryngology | 2528 W 16th St, Greeley, CO 80634-4955 | 2006-04-28 |
| 1043298870 | Sanjay K Gupta | Otolaryngology | 6500 29th Street, Suite 106, Greeley, CO 80634-8386 | 2006-01-03 |
| 1851682090 | Thomas Maxwell Fissenden | Otolaryngology | 5881 W 16th St, Greeley, CO 80634-2910 | 2011-04-21 |
| 1063659522 | Front Range Ent, PC | Otolaryngology | 6500 29th Street, Suite 106, Greeley, CO 80634-8386 | 2009-01-20 |
| 1841240991 | Thomas T Peterson | Otolaryngology | 5881 W 16th St, Greeley, CO 80634-2910 | 2006-05-11 |
| 1124086731 | Keith E Peterson | Otolaryngology | 2528 W 16th St, Greeley, CO 80634-4955 | 2006-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063027225 | Barry Berlin | Otolaryngology | 1133 14th St Unit 3800, Denver, CO 80202-2277 | 2020-09-14 |
| 1972112472 | Portercare Adventist Health System | Otolaryngology | 9399 Crown Crest Blvd Ste 401, Parker, CO 80138-8540 | 2020-07-30 |
| 1063048528 | Healthone Clinic Services - Otolaryngology Specialists LLC | Otolaryngology | 14100 E Arapahoe Rd Ste 250, Centennial, CO 80112-4028 | 2020-03-17 |
| 1407482144 | Healthone Clinic Services - Otolaryngology Specialists LLC | Otolaryngology | 7180 E Orchard Rd Ste 202, Centennial, CO 80111-1726 | 2020-03-13 |
| 1598128266 | Edward J Hepworth Md PC | Otolaryngology | 3150 E 3rd Ave, Denver, CO 80206-5245 | 2016-03-31 |
| 1467829309 | Pikes Peak Ent | Otolaryngology | 9475 Briar Village Pt Ste 225, Colorado Springs, CO 80920 | 2015-08-26 |
| 1811376593 | Lauren Sowa | Otolaryngology | 12631 E 17th Ave # Ms 205, Aurora, CO 80045-2527 | 2015-05-27 |
| 1417343153 | Ralph Talbot Kendall | Otolaryngology | 3502 Pine Tree Sq, Colorado Springs, CO 80909-6436 | 2015-04-09 |
| 1134513351 | Planet T Hormone Replacement Center | Otolaryngology | 2631 W Colorado Ave, Colorado Springs, CO 80904-3024 | 2015-03-25 |
| 1699039156 | Catholic Health Initiatives Colorado | Otolaryngology | 11700 W 2nd Pl Ste 435, Lakewood, CO 80228-1732 | 2012-06-29 |
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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.