POUDRE VALLEY MEDICAL GROUP, LLC


Address: 255 N 30th St, Laramie, WY 82072-5140
Phone: 3077429411

POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1992336168) 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) 1992336168
Entity Type Organization
Organization Name POUDRE VALLEY MEDICAL GROUP, LLC
Other Organization Name UCHEALTH HEART AND VASCULAR CLINIC - LARAMIE
Practice Address 255 N 30th St
Laramie
WY 82072-5140
Mailing Address 2695 Rocky Mountain Ave Ste 150
Loveland
CO 80538-9071
Practice Telephone 3077429411
Practice Fax Number 3077429423
Mailing Telephone 3077429411
Mailing Fax Number 3077429423
Enumeration Date 2020-01-28
Last Update Date 2020-04-09
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 207RC0000X Internal Medicine
Specialization: Cardiovascular Disease
Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
UCHealth Heart and Vascular Clinic - Laramie Other Name - Individual/Organization
UCHealth Heart and Vascular Visiting Specialty Clinic - Laramie Doing Business As Name - 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 255 N 30TH ST
City LARAMIE
State WY
Zip Code 82072-5140

Providers in the same location

NPI Name Taxonomy Address Enumeration
1679553986 Tonja Marie Woods Pharmacist 255 N 30th St, Laramie, WY 82072-5140 2006-01-20
1699300525 Sarah Kiana Haynes Dietitian, Registered 255 N 30th St, Laramie, WY 82072-5195 2020-03-11
1962062638 Thomas Richard Harold Witkop Nurse Practitioner 255 N 30th St, Laramie, WY 82072-5140 2019-06-16
1225598097 Adrianne Kate Griebel Dietitian, Registered 255 N 30th St, Laramie, WY 82072-5140 2019-03-20
1467920512 Elizabeth Morissette Rowe Advanced Practice Midwife 255 N 30th St, Laramie, WY 82072-5140 2018-11-07
1477049039 Samuel Brauninger Nurse Anesthetist, Certified Registered 255 N 30th St, Laramie, WY 82072-5140 2018-07-07
1376042960 Candace Mae Burch Nurse Practitioner 255 N 30th St, Laramie, WY 82072-5140 2018-02-08
1639698608 Jason Lee Sondgeroth Nurse Practitioner 255 N 30th St, Laramie, WY 82072-5140 2017-09-11
1356722003 Nathan Valencia Still Internal Medicine 255 N 30th St, Laramie, WY 82072 2015-06-17
1235522715 Dianne Rougeau-tingey Nutritionist 255 N 30th St, Laramie, WY 82072-5140 2015-03-09
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1629688924 Colby Wolf 16th & Gibbon, Department 3414, Laramie, WY 82072 2020-08-03
1871947341 Curran Quast Case Manager/Care Coordinator 1465 N 4th St Ste 111, Laramie, WY 82072 2016-04-20
1184030827 David Hokanson Dentist 352 N. 4th Street, Laramie, WY 82072 2014-07-02
1356673297 Aaron Lozano Counselor 1465 N. 4th Street #119, Laramie, WY 82072 2010-02-03
1407181092 Maureen K. Johnson Inc In Home Supportive Care 2010 Reynolds H280, Laramie, WY 82072 2009-10-15
1316120991 Nephrology Clinic PC Clinic/Center 3116 Willet Dr, Laramie, WY 82072 2007-12-06
1851410682 Laramie Reproductive Health Public Health or Welfare 1252 N 22nd St Suite A, Laramie, WY 82072 2007-03-29
1942345327 Fike Chiropractic Pain Relief Chiropractor 1267 N 15th St, Suite 123b, Laramie, WY 82072 2007-02-21
1336215441 Laramie Pediatrics Internal Medicine Internal Medicine 1252 North 22nd St, Ste B, Laramie, WY 82072 2006-11-28
1407939218 Ark Regional Services, Inc Occupational Therapist 1150 N 3rd Street, Laramie, WY 82072 2006-10-23
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Taxonomy Information

Taxonomy Code 207RC0000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Cardiovascular Disease

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1205456035 Poudre Valley Medical Group, LLC Internal Medicine 3116 Willett Dr, Laramie, WY 82072-5048 2020-04-22

Providers in the same taxonomy and state

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
1164524823 John Edward Glode Internal Medicine 1200 E 20th St Ste A, Cheyenne, WY 82001-3979 2006-09-02
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
1629019351 Larry J Hattel Internal Medicine 3235 Sparks Rd, Suite 200, Cheyenne, WY 82001-6158 2006-06-10
1891748703 John William Pickrell Internal Medicine 1230 E 1st St, Casper, WY 82601-2704 2006-05-19
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Competitor

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City LARAMIE
Zip Code 82072

Improve Information

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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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