Provider Demographics
NPI:1881218519
Name:PLATTE VALLEY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:PLATTE VALLEY MEDICAL GROUP, LLC
Other - Org Name:FORT LUPTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
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 1:1450 DEXTER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1503
Mailing Address - Country:US
Mailing Address - Phone:303-857-2087
Mailing Address - Fax:303-857-2385
Practice Address - Street 1:1450 DEXTER ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1503
Practice Address - Country:US
Practice Address - Phone:303-857-2087
Practice Address - Fax:303-857-2385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTON COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-28
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty