Provider Demographics
NPI:1417574393
Name:PLATTE VALLEY MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:PLATTE VALLEY MEDICAL GROUP LLC
Other - Org Name:PLATTE VALLEY CLINIC - NURSE MIDWIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-272-0231
Mailing Address - Street 1:1606 PRAIRIE CENTER PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-318-2229
Mailing Address - Fax:720-501-6701
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY STE 210
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-318-2229
Practice Address - Fax:720-501-6701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTON COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-26
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty