NPI |
1518597137 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
POUDRE VALLEY MEDICAL GROUP, LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
UCHEALTH CANCER CARE AND HEMATOLOGY CLINIC - WRAY |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Provider First Line Business Practice Location Address |
1017 W 7TH ST |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Business Practice Location Address City Name |
WRAY |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Business Practice Location Address State Name |
CO |
The first name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address Postal Code |
807581420 |
The middle name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider Business Practice Location Address Telephone Number |
9702377700 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider Enumeration Date |
1/23/2020 |
Other last name by which the provider being identified is or has been known. |
Last Update Date |
1/27/2020 |
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only. |
Authorized Official Last Name |
CONROY |
Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider
is or has been known by a different last name only. |
Authorized Official First Name |
JANA |
The other name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Authorized Official Title or Position |
CREDENTIALING MANAGER |
The other abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Authorized Official Telephone Number |
9706244443 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Healthcare Provider Taxonomy Code 1 |
207RH0003X |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Is Organization Subpart |
N |
|
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|