Provider Demographics
NPI:1457975161
Name:PLATTE VALLEY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:PLATTE VALLEY MEDICAL GROUP, LLC
Other - Org Name:REUNION CLINIC INTERNAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER ENROLLMENT
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 1:10569 CHAMBERS RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-8951
Mailing Address - Country:US
Mailing Address - Phone:303-286-6250
Mailing Address - Fax:303-227-6721
Practice Address - Street 1:10569 CHAMBERS RD UNIT 102
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-8951
Practice Address - Country:US
Practice Address - Phone:303-286-6250
Practice Address - Fax:303-227-6721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTON COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-29
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty