POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1447872460) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447872460 |
| Entity Type | Organization |
| Organization Name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Practice Address |
1925 Mountain View Ave Longmont CO 80501-3128 |
| Mailing Address |
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 |
| Practice Telephone | 7207188070 |
| Practice Fax Number | 7204943107 |
| Mailing Telephone | 7207188070 |
| Mailing Fax Number | 7204943107 |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2020-05-13 |
| 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 | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| UCHealth Neurology Clinic - Longmont | 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 |
1925 MOUNTAIN VIEW AVE |
| City | LONGMONT |
| State | CO |
| Zip Code | 80501-3128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275538555 | Amy Lou Johnson | Obstetrics & Gynecology | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2005-06-14 |
| 1013522192 | Poudre Valley Medical Group, LLC | Urology | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2020-09-15 |
| 1164037248 | Poudre Valley Medical Group, LLC | Obstetrics & Gynecology | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2020-09-15 |
| 1003421306 | Poudre Valley Medical Group, LLC | Urology | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2020-09-14 |
| 1922613603 | Poudre Valley Medical Group, LLC | Internal Medicine | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2020-09-10 |
| 1679186803 | Poudre Valley Medical Group, LLC | Internal Medicine | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2020-08-27 |
| 1942813167 | Poudre Valley Medical Group, LLC | Internal Medicine | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2020-08-27 |
| 1194338319 | Poudre Valley Medical Group, LLC | Radiology | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2020-08-27 |
| 1740893197 | Poudre Valley Medical Group, LLC | Surgery | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2020-08-26 |
| 1073126652 | Poudre Valley Medical Group, LLC | Pediatrics | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2020-08-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598376774 | Boulder County Public Health | Public Health or Welfare | 515 Coffman Street, Suite 200, Longmont, CO 80501 | 2020-08-12 |
| 1164032827 | Kidstuff Child and Family Counseling, P.C. | Marriage & Family Therapist | 360 15th Ave, Ste. 104, Longmont, CO 80501 | 2020-08-06 |
| 1861036501 | Stateserv Medical of Colorado | Durable Medical Equipment & Medical Supplies | 63 South Pratt Pkwy, Landmont, CO 80501 | 2019-11-06 |
| 1558915090 | Array Clinical and Therapeutic Services | Assistant Behavior Analyst | 451 21st Ave. Suite B, Longmont, CO 80501 | 2019-08-01 |
| 1275195042 | Alisa Marie Schwegerl | Speech-Language Pathologist | 1800 Stroh Place, Longmont, CO 80501 | 2019-07-02 |
| 1295298545 | Jovahna Pena | Counselor | Behavioral Health Group, 850 23rd Ave Unit A, Longmont, CO 80501 | 2019-04-12 |
| 1659845568 | University Physicians Incorporated | Advanced Practice Midwife | 2030 Mountain View Ave Ste 400, Longmont, CO 80501 | 2019-01-14 |
| 1013404714 | Crafted Physical Therapy Pllc | Physical Therapist | 701 Delaware Ave Unit E, Longmont, CO 80501 | 2018-04-18 |
| 1588110860 | Randall Bonnom | Counselor | 420 21st Ave #113, Longmont, CO 80501 | 2016-08-28 |
| 1225401771 | Sowash Optometry Group, PC | Eyewear Supplier (Equipment, not the service) | 1242 S. Hover Street, Suite C200, Longmont, CO 80501 | 2015-11-05 |
| Find all providers in zip 80501 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295726453 | Badreldin A Ibrahim | Psychiatry & Neurology | 1511 Onyx Cir, Longmont, CO 80504-7805 | 2005-11-04 |
| 1285631440 | Pierre V Pavot | Psychiatry & Neurology | 2030 Mountain View Ave, Suite 300, Longmont, CO 80501-3178 | 2005-07-03 |
| 1124483342 | Bruce Katuna, Md | Psychiatry & Neurology | 1511 Onyx Cir, Longmont, CO 80504-7805 | 2015-12-16 |
| 1992179394 | Blaze Iom Reading, Pllc | Psychiatry & Neurology | 1511 Onyx Cir, Longmont, CO 80504-7805 | 2015-11-23 |
| 1932513124 | Diana Oyoung-oliver | Psychiatry & Neurology | 1925 Mountain View Ave, Longmont, CO 80501-3128 | 2014-06-16 |
| 1568696243 | Gregory J. Ferenz | Psychiatry & Neurology | 1511 Onyx Cir, Longmont, CO 80504-7805 | 2009-05-08 |
| 1447467246 | Paul Andrew Sykes | Psychiatry & Neurology | 1925 Mountain View Ave, Longmont, CO 80501 | 2007-05-17 |
| 1376757344 | Grant Michael Warmouth | Psychiatry & Neurology | 1511 Onyx Cir, Longmont, CO 80504-7805 | 2007-05-09 |
| 1790847705 | Colorado Institute for Neuromuscular and Neurological Disorders, Pllc | Psychiatry & Neurology | 600 S Airport Rd, Suite E, Bldg. B, Longmont, CO 80503-6424 | 2006-12-15 |
| 1073615704 | Bruce Alan Katuna | Psychiatry & Neurology | 1511 Onyx Cir, Longmont, CO 80504-7805 | 2006-09-02 |
| Find all providers in LONGMONT | ||||
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.