| Poudre Valley Medical Group, Llc | |
|
4110 Briargate Pkwy Ste 405 Colorado Springs CO 80920-7838 | |
| (719) 364-6550 | |
| Not Available |
| Full Name | Poudre Valley Medical Group, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 4110 Briargate Pkwy Ste 405, Colorado Springs, Colorado |
| Authorized Official Name and Position | Jana Conroy (MANAGER CREDENTIALING) |
| Authorized Official Contact | 9706244443 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Poudre Valley Medical Group, Llc 2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 Ph: (970) 624-4443 | Poudre Valley Medical Group, Llc 4110 Briargate Pkwy Ste 405 Colorado Springs CO 80920-7838 Ph: (719) 364-6550 |
| NPI Number | 1396338398 |
|---|---|
| Provider Enumeration Date | 02/19/2021 |
| Last Update Date | 02/19/2021 |
| Certification Date | 02/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396338398 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
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