Provider Demographics
NPI:1255729380
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:SR. VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:RIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-495-7000
Mailing Address - Street 1:7901 E. LOWRY BLVD.
Mailing Address - Street 2:F402, 3RD FLOOR
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POUDRE VALLEY HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO010305332B00000X, 3336C0002X, 3336C0003X, 3336C0004X, 3336S0011X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0623238OtherNCPDP
COB001OtherTRICARE
COH188OtherMIDLAND'S CHOICE
WY1192523-00Medicaid
CO0694280OtherAETNA
CO44054OtherGOV EMPLOYEE HOSPITAL ASSOCIATION
CO75276OtherWORLD INSURANCE
CO96934832OtherCOLORADO INDIGENT
CO618515OtherSTATE FARM
CO6160355OtherAMERICA'S HEALTH PLAN
CO00025POOtherBLUE CROSS COLORADO
CODE0901OtherRAILROAD MEDICARE
CO86373251OtherMEDICAID RTCF
CO0623238OtherNCPDP
COB001OtherTRICARE
CO00025POOtherBLUE CROSS COLORADO
CO96934832OtherCOLORADO INDIGENT
CODE0901OtherRAILROAD MEDICARE
COH188OtherMIDLAND'S CHOICE
CO6160355OtherAMERICA'S HEALTH PLAN
CO05010004Medicaid