Provider Demographics
NPI:1760492714
Name:POUDRE VALLEY HEALTH CARE INC.
Entity Type:Organization
Organization Name:POUDRE VALLEY HEALTH CARE INC.
Other - Org Name:POUDRE VALLEY HOSPITAL
Other - Org Type:Doing Business As
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 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1024 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3929
Practice Address - Country:US
Practice Address - Phone:970-495-7000
Practice Address - Fax:970-495-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QE0002X, 273R00000X, 273Y00000X, 343900000X
CO0050282N00000X
CO010305333600000X
CO341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
No333600000XSuppliersPharmacy
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81933762Medicaid
CO86373251OtherMEDICAID RTCF
CO0694280OtherAETNA
CO618515OtherSTATE FARM
CO00025POOtherBLUE CROSS COLORADO
CO06060123Medicaid
CO6160355OtherAMERICA'S HEALTH PLAN
CODE0901OtherRAILROAD MEDICARE
CO05010004Medicaid
CO96934832OtherCOLORADO INDIGENT
COH188OtherMIDLANDS CHOICE
CO44054OtherGOV EMPLOYEE HOSPITAL ASS
COB001OtherTRICARE WPS
COD8004OtherMEDICARE PART B
WY1192523-00Medicaid
CO75276OtherWORLD INSURANCE
CO0694280OtherAETNA
NE=========00Medicaid
CO618515OtherSTATE FARM
CO06060123Medicaid
CO060010Medicare Oscar/Certification
NE=========00Medicaid
CO06060123Medicaid