POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1659984003) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659984003 |
| Entity Type | Organization |
| Organization Name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Practice Address |
1400 E Boulder St Ste 600 Colorado Springs CO 80909-5533 |
| Mailing Address |
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 |
| Practice Telephone | 7193657340 |
| Practice Fax Number | 7193657349 |
| Mailing Telephone | 7193657340 |
| Mailing Fax Number | 7193657349 |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2020-08-26 |
| 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 | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers |
| Other Name | Type Code |
|---|---|
| UCHealth Podiatry Clinic - Memorial Hospital Central | 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 |
1400 E BOULDER ST STE 600 |
| City | COLORADO SPRINGS |
| State | CO |
| Zip Code | 80909-5533 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245217108 | David C Corry | Surgery | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2005-12-30 |
| 1477168557 | Poudre Valley Medical Group, LLC | Surgery | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2020-09-15 |
| 1447769351 | Bartlomiej Lipko | Physician Assistant | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2017-09-22 |
| 1982052510 | Renaie Leblond | Physician Assistant | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2016-05-24 |
| 1093188773 | Michelle S. Janowsky | Physician Assistant | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2015-11-03 |
| 1902298771 | Molly Beth Peterlin | Physician Assistant | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2015-03-03 |
| 1477983369 | Christopher Dorozynski | Physician Assistant | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2013-11-14 |
| 1154671295 | Julie Ann Caballero | Physician Assistant | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2012-09-17 |
| 1043570161 | Brett Allen Fair | Surgery | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909 | 2012-05-22 |
| 1841578069 | Erin Renee Henzler | Physician Assistant | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2011-07-22 |
| Find all providers in the same location | ||||
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|---|---|---|---|---|
| 1376173765 | Ascent Health LLC | Community/Behavioral Health | 2608 Palmer Park Blvd., Colorado Springs, CO- COLORADO 80909 | 2020-01-24 |
| 1639714041 | Peak Vista Community Health Centers | Clinic/Center | 4041 E San Miguel St, Colorado Springs, CO 80909 | 2019-11-08 |
| 1437706231 | Cvs Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 445 N Circle Drive, Colorado Springs, CO 80909 | 2019-08-26 |
| 1760952964 | James Garofalo | Counselor | 2210 E La Salle St Ste 221, Colorado Spgs, CO 80909 | 2018-11-29 |
| 1144719055 | Autumn Leaves Counseling, LLC | Counselor | 2130 Academy Circle, Suite B, Co Springs, CO 80909 | 2018-05-07 |
| 1407353642 | Ambulnz Co, LLC | Ambulance | 2420 E Pikes Peak Ave Ste 1001, Colorado Springs, CO 80909 | 2018-04-12 |
| 1083117998 | Peak Wellness Counseling Service, LLC | Counselor | 2210 E. La Salle Street, Suite 208, Colorado Springs, CO 80909 | 2018-03-16 |
| 1043740822 | Ande Carol West | Dental Hygienist | 701 Citadel Drive East, Colorado Springs, CO 80909 | 2017-06-14 |
| 1043748791 | Colorado Springs Pharmacy LLC | Pharmacy | 2224 E. Pikes Peak Ave, Colorado Springs, CO 80909 | 2017-05-25 |
| 1215484365 | Brittney Nicole Roberts | Physical Therapist | 2201 Lelaray St., Colorado Springs, CO 80909 | 2016-09-07 |
| Find all providers in zip 80909 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376606392 | Kenneth N Coates | Podiatrist | 1512 N Union Blvd, Suite 100, Colorado Springs, CO 80909-2810 | 2006-12-19 |
| 1861411225 | Judson T Davis | Podiatrist | 1955 Dominion Way, Suite 130, Colorado Springs, CO 80918-1480 | 2006-07-18 |
| 1568455061 | Gerald Richard Travers | Podiatrist | 1612 E Pikes Peak Ave, Colorado Springs, CO 80909-5619 | 2005-08-30 |
| 1831181536 | Jeremy A Mcvay | Podiatrist | 8580 Scarborough Dr Ste 120, Colorado Springs, CO 80920-7583 | 2005-08-18 |
| 1184616278 | John Robert Swenson | Podiatrist | 2287 Rocking Horse Ct, Colorado Springs, CO 80921-6401 | 2005-08-16 |
| 1427058155 | Stanton Clair Southward | Podiatrist | 1900 E Pikes Peak Ave, Suite 4, Colorado Springs, CO 80909-5850 | 2005-07-22 |
| 1831196815 | Kerry Elizebeth Berg | Podiatrist | 9348 Grand Cordera Pkwy Ste 210, Colorado Springs, CO 80924 | 2005-07-05 |
| 1316467459 | Maya Christie Trueman | Podiatrist | 455 E Pikes Peak Ave Ste 220, Colorado Springs, CO 80903-3673 | 2017-06-20 |
| 1770712424 | Michael Scott Peck | Podiatrist | 1155 Kelly Johnson Blvd, #310, Colorado Springs, CO 80920-3932 | 2009-07-02 |
| 1003050899 | Matthew Diehl Hinderland | Podiatrist | 1465 Kelly Johnson Blvd Ste 100, Colorado Springs, CO 80920-3945 | 2009-04-24 |
| Find all providers in COLORADO SPRINGS | ||||
| City | COLORADO SPRINGS |
| Zip Code | 80909 |
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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.