| Organization Name: | POUDRE VALLEY MEDICAL GROUP, LLC |
| NPI Number: | 1366763260 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBBIE CHANDLER (CEO) |
| Mailing Address: | 2695 Rocky Mountain Ave Suite 150 Loveland |
| State: | CO US |
| Postal Code: | 805388702 |
| Phone Number: | 9706244420 |
| Fax Number: | 9706244459 |
| NPI Enumeration Date: | 06/15/2010 |
| NPI Last Update Date: | 03/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |