POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1730794819) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730794819 |
| Entity Type | Organization |
| Organization Name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Practice Address |
4110 Briargate Pkwy Ste 140 Colorado Springs CO 80920-7836 |
| Mailing Address |
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 |
| Practice Telephone | 7193648346 |
| Practice Fax Number | 7193648347 |
| Mailing Telephone | 7193648346 |
| Mailing Fax Number | 7193648347 |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2020-09-15 |
| 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 | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| UCHealth Vein and Vascular Surgery Center - Memorial Hospital North | 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 |
4110 BRIARGATE PKWY STE 140 |
| City | COLORADO SPRINGS |
| State | CO |
| Zip Code | 80920-7836 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518045905 | Patrick I Burns | Surgery | 4110 Briargate Pkwy Ste 140, Colorado Springs, CO 80920-7836 | 2006-11-01 |
| 1881998847 | Mark Braun | Nurse Practitioner | 4110 Briargate Pkwy Ste 140, Colorado Springs, CO 80920-7836 | 2011-01-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407463409 | Cynthia Cruz | Marriage & Family Therapist | 7710 N. Union, Ste 100b and 100c, Colorado Springs, CO 80920 | 2020-09-24 |
| 1851905178 | Emergency Medical Specialists, PC | Emergency Medicine | Woodmen Fsed - Md, 3790 E. Woodmen Road, Colorado Springs, CO 80920 | 2020-09-03 |
| 1114531431 | Emergency Medical Specialists, PC | Emergency Medicine | Memorial Hospital North - Md, 4050 Briargate Pkway, Colorado Springs, CO 80920 | 2020-09-03 |
| 1205440583 | Emergency Medical Specialists, PC | Emergency Medicine | Memorial Hospital North - App, 4050 Briargate Pkway, Colorado Springs, CO 80920 | 2020-09-03 |
| 1700490455 | Poudre Valley Medical Group, LLC | Radiology | 4080 Briargate Parkway, Colorado Springs, CO 80920 | 2020-09-01 |
| 1962015792 | Emergency Medical Specialists, PC | Emergency Medicine | Woodmen Fsed - App, 3790 E. Woodmen Road, Colorado Springs, CO 80920 | 2020-08-31 |
| 1194296491 | Kramer Dentistry Inc | Clinic/Center | 9290 Highland Ridge Heights Suite # 120, Colorado Springs, CO 80920 | 2018-12-12 |
| 1134602279 | Juliana Plucinik | Assistant Behavior Analyst | 7011 Campus Drive Suite 205, Colorado Springs, CO 80920 | 2018-09-14 |
| 1811473861 | Vsb Colorado Providers Pllc | Dentist | 1750 Telstar Drive, Suite 200, Colorado Springs, CO 80920 | 2018-07-12 |
| 1336637438 | Children's Hospital Colorado | General Acute Care Hospital | 4090 Briargate Parkway, Colorado Springs, CO 80920 | 2018-04-25 |
| Find all providers in zip 80920 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275896508 | Dmitriy Rybitskiy | Surgery | 2222 N Nevada Ave Ste 5010, Colorado Springs, CO 80907-6865 | 2012-06-21 |
| 1124008032 | Joseph Thomas Crepps Jr. | Surgery | 3220 Orion Dr, Colorado Springs, CO 80906-0920 | 2006-01-18 |
| 1477168557 | Poudre Valley Medical Group, LLC | Surgery | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2020-09-15 |
| 1316986060 | John Miller Conn Sr. | Surgery | 2222 N Nevada Ave, Suite 5017, Colorado Springs, CO 80907-6819 | 2006-06-06 |
| 1700839248 | Parkside Ct Group LLC | Surgery | 215 Parkside Dr, Colorado Springs, CO 80910-3135 | 2006-05-18 |
| 1730130337 | Laura C Kissell | Surgery | 1400 E Boulder St Ste 600, Colorado Springs, CO 80909-5533 | 2006-05-16 |
| 1073593901 | Colorado Springs Vascular, P.C. | Surgery | 175 S Union Blvd, Suite 320, Colorado Springs, CO 80910-3113 | 2006-01-18 |
| 1427038330 | Scott Newton Hurlbert | Surgery | 1400 E Boulder St, Ste 600, Colorado Springs, CO 80909-5533 | 2006-01-18 |
| 1295715225 | Karl Paul Dittrich | Surgery | 175 S Union Blvd, Suite 320, Colorado Springs, CO 80910-3113 | 2006-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831706506 | University Physicians, Incorporated | Surgery | 13100 E Colfax Ave Ste 70, Aurora, CO 80011-5517 | 2020-09-28 |
| 1376015297 | Molly Goldstein | Surgery | 1401 Court St, Pueblo, CO 81003-2715 | 2018-12-18 |
| 1437412723 | Junior Univers | Surgery | 2643 Patterson Rd Ste 401, Grand Junction, CO 81506-1937 | 2012-06-21 |
| 1518230333 | James Gilbert Chandler | Surgery | 3721 Mountain Laurel Pl, Boulder, CO 80304-0798 | 2012-02-10 |
| 1982982567 | Benson M Powell II | Surgery | 2572 Silver Oak Ct, Grand Junction, CO 81505-1091 | 2011-07-29 |
| 1205078912 | Rafael Demarchi Malgor | Surgery | 12631 E 17th Ave # Msc312, Aurora, CO 80045-2527 | 2009-03-26 |
| 1770610735 | Thomas F Rehring | Surgery | 2045 N Franklin St Fl 3, Denver, CO 80205-5437 | 2007-02-27 |
| 1770624298 | Charles O Brantigan Md | Surgery | 2253 Downing St, Denver, CO 80205-5234 | 2007-02-09 |
| 1588717656 | Cass William Conaway | Surgery | 721 19th St, Denver, CO 80202-2500 | 2007-01-19 |
| 1053464669 | Cardiovascular and Thoracic Surgical Associates | Surgery | 1600 N Grand Ave Ste 500, Pueblo, CO 81003-2757 | 2007-01-18 |
| Find all providers with the same taxonomy | ||||
| City | COLORADO SPRINGS |
| Zip Code | 80920 |
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.