POUDRE VALLEY MEDICAL GROUP LLC NPI 1275134900

NPI Information

POUDRE VALLEY MEDICAL GROUP, LLC is a plastic and reconstructive surgery surgery in Fort Collins, CO. The provider is a surgeon who specializes in plastic and reconstructive surgery. POUDRE VALLEY MEDICAL GROUP, LLC NPI is 1275134900. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2315 E HARMONY RD STE 160
FORT COLLINS, CO
ZIP 80528-620
Phone: (970) 493-8800
Fax: (970) 498-8800

The provider's authorized official is Jana Conroy .
The authorized official title is Credentialing Manager and has the following contact phone number (970) 624-4443.

The enumeration date for this NPI number is 11/9/2020 and was last updated on 11/9/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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