POUDRE VALLEY MEDICAL GROUP, LLC


Address: 175 S Union Blvd Ste 240, Colorado Springs, CO 80910-3125
Phone: 7193656300

POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1609485648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1609485648
Entity Type Organization
Organization Name POUDRE VALLEY MEDICAL GROUP, LLC
Practice Address 175 S Union Blvd Ste 240
Colorado Springs
CO 80910-3125
Mailing Address 2695 Rocky Mountain Ave Ste 150
Loveland
CO 80538-9071
Practice Telephone 7193656300
Practice Fax Number 7193656094
Mailing Telephone 7193656300
Mailing Fax Number 7193656094
Enumeration Date 2020-07-27
Last Update Date 2020-07-27
Authorized Official Name JANA CONROY (CREDENTIALING MANAGER)
Authorized Official Telephone 9706244443
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103G00000X Clinical Neuropsychologist Behavioral Health & Social Service Providers

Other Provider/Organization Names

Other Name Type Code
UCHealth Neuropsychology Clinic - Colorado Springs Other Name - Individual/Organization

Other Provider IDs and Locations

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

Other Data Sources

Entity Type Entity Name Entity Address
Colorado Business Entities Poudre Valley Medical Group, LLC 2695 Rocky Mountain Ave., Suite 110, Loveland, CO 80538

Office Location

Street Address 175 S UNION BLVD STE 240
City COLORADO SPRINGS
State CO
Zip Code 80910-3125

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1952955403 Marian Lin Mondy Social Worker 2909 Wellshire Blvd., Colorado Springs, CO 80910 2019-08-01
1538727474 Lisa Morales Audiologist 3225 International Cir Ste 102, Colorado Springs, CO 80910 2019-06-05
1134617038 Paul Gross Counselor 411 Lakewood Circle Dr, C-204-b, Colorado Springs, CO 80910 2018-04-25
1821502923 Kathleen Lubos Ambros-dahilig Dental Assistant 2240 Gilpin Ave, Colorado Springs, CO 80910 2017-11-28
1508384793 Shawn Maul Registered Nurse 115 S Parkside, Colorado Springs, CO 80910 2017-09-07
1376910521 Kelley Elizabeth Smith Bouchard Nurse Practitioner 3225 International Circle Suite 220, Colorado Springs, CO 80910 2015-08-24
1619353430 Dr. Steven Alan Gould Dds PC Dentist 2859 E. Fountain Blvd, Colorado Springs, CO 80910 2015-08-04
1881029155 Francis Hammet Chiropractor 411 Lakewood Circle A1104, Colorado Springs, CO 80910 2013-09-05
1447697586 Mcb Clinical Research Centers, LLC Psychologist 110 S. Parkside Drive, Colorado Springs, CO 80910 2013-05-30
1417206723 Augustus Albert Edwards Case Manager/Care Coordinator 115 Parkside Drive, Colorado Springs, CO 80910 2012-08-31
Find all providers in zip 80910

Taxonomy Information

Taxonomy Code 103G00000X
Grouping Behavioral Health & Social Service Providers
Classification Clinical Neuropsychologist

Taxonomy Definition

An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning.
Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1972048098 Neurofeedback Colorado Springs, Inc. Clinical Neuropsychologist 2918 Beacon St Ste A, Colorado Springs, CO 80907-9208 2016-12-28
1316252521 James C Stewart Phd Professional Corporation Clinical Neuropsychologist 2020 Bramblwood Ln, Colorado Springs, CO 80920-1588 2010-08-11
1386962231 Cassie Ann Faulhaber Clinical Neuropsychologist 4863 N. Nevada Ave., Ste. 321, Colorado Springs, CO 80918 2010-05-16
1184941726 Cassie Faulhaber, Psy.d., Pllc Clinical Neuropsychologist 4863 N. Nevada, Suite 321, Colorado Springs, CO 80918 2010-04-21
1629301429 David Jeffrey Stephens Clinical Neuropsychologist 402 Garden of The Gods Rd, Colorado Springs, CO 80907 2009-09-10
1083779847 John Manuel Bermudez Clinical Neuropsychologist 2930 Austin Bluffs Pkwy, Suite 102, Colorado Springs, CO 80918-5763 2006-12-22
1215096904 Lillian M. Moeller Clinical Neuropsychologist 10 Boulder Crescent St Ste 101b, Colorado Springs, CO 80903-3344 2006-12-08
1851499305 David Shapiro Clinical Neuropsychologist 1301 8th Street, Suite 301, Colorado Springs, CO 80906 2006-09-20
1518902402 Julie Denise Rippeth Clinical Neuropsychologist 4820 Rusina Rd Ste C, Colorado Springs, CO 80907-8127 2006-06-17
1851874150 Jace Michael Waguspack Clinical Neuropsychologist 1725 E Boulder St Ste 101, Colorado Springs, CO 80909-5740 2018-09-12
Find all providers in COLORADO SPRINGS

Competitor

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City COLORADO SPRINGS
Zip Code 80910

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Dataset Information

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.

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