| Poudre Valley Medical Group, Llc | |
|
56 Club Manor Dr Ste 100 Pueblo CO 81008-1685 | |
| (719) 584-4767 | |
| (719) 595-7906 |
| Full Name | Poudre Valley Medical Group, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 56 Club Manor Dr Ste 100, Pueblo, Colorado |
| Authorized Official Name and Position | Jana Conroy (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 7195844767 |
| 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: () - | Poudre Valley Medical Group, Llc 56 Club Manor Dr Ste 100 Pueblo CO 81008-1685 Ph: (719) 584-4767 |
| NPI Number | 1063209534 |
|---|---|
| Provider Enumeration Date | 04/21/2025 |
| Last Update Date | 04/21/2025 |
| Certification Date | 04/21/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063209534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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