Organization · Type 2 NPI

Poudre Valley Medical Group, LLC

Plastic and Reconstructive Surgery Physician · Pueblo, CO

NPI number 1396531745 Active

Practice location

1600 N Grand Ave Ste 230
Pueblo, CO 81003-2731

Call (719) 542-2470 Map

Fax (719) 542-2465

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071

Specialties and licenses

Taxonomy	Code	License
Plastic and Reconstructive Surgery Physician Primary	2086S0122X	None listed

Plastic and Reconstructive Surgery Physician: A surgeon who specializes in plastic and reconstructive surgery.

Other plastic and reconstructive surgery physician providers in Pueblo

CK Surgical LLCPlastic and Reconstructive Surgery Physician Pueblo, CO NPI 1285652966

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NPI record

NPI: 1396531745
Entity type: Organization (Type 2)
Issued: Apr 15, 2025
Last updated: Apr 15, 2025
Status: Active
Subpart: Yes of Poudre Valley Medical Group, LLC

Other names

Uchealth Medical Group · doing business as
Uchealth Plastic and Reconstructive Surgery Clinic - Parkview Mob · other name

Authorized official

Jana Conroy
Director of Credentialing
(719) 542-2470

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1396531745

Poudre Valley Medical Group, LLC's National Provider Identifier is 1396531745, issued on Apr 15, 2025. The primary taxonomy on file is Plastic and Reconstructive Surgery Physician (2086S0122X), and the practice location is in Pueblo, CO. The record was last updated on Apr 15, 2025.