Provider Demographics
NPI:1144535444
Name:POUDRE VALLEY HEALTH CARE, INC
Entity type:Organization
Organization Name:POUDRE VALLEY HEALTH CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-495-7000
Mailing Address - Street 1:7901 E LOWRY BLVD
Mailing Address - Street 2:MAIL STOP F402
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 PENNOCK PL STE 121
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3250
Practice Address - Country:US
Practice Address - Phone:970-495-8980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POUDRE VALLEY HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-11
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40486061Medicaid
COCD3123OtherMEDICARE RAILROAD
COCD3123OtherMEDICARE RAILROAD