| Organization Name: | POUDRE VALLEY MEDICAL GROUP, LLC |
| NPI Number: | 1396062139 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARBARA YOSSES (VP AMBULATORY SERVICES) |
| Mailing Address: | 1107 S Lemay Ave Suite 240 Ft Collins |
| State: | CO US |
| Postal Code: | 805243959 |
| Phone Number: | 9704957420 |
| Fax Number: | |
| NPI Enumeration Date: | 05/03/2010 |
| NPI Last Update Date: | 05/03/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0120X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Pediatric Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. |