Provider Demographics
NPI:1215332762
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:CHIEF FINANCIAL OFFICER
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:970-207-4800
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:80230-6507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4601 CORBETT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-9579
Practice Address - Country:US
Practice Address - Phone:970-207-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POUDRE VALLEY HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-27
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO273R00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00025POOtherBLUE CROSS COLORADO
CO6160355OtherAMERICA'S HEALTH PLAN
CO75276OtherWORLD INSURANCE
CO86373251OtherMEDICAID RTCF
COH188OtherMIDLANDS CHOICE
CO44054OtherGOV EMPLOYEE HOSPITAL ASSOCIATION
CO05010004Medicaid
CO618515OtherSTATE FARM
COB001OtherTRICARE WPS
CO06060123Medicaid
CO81933762Medicaid
CODE0901OtherRAILROAD MEDICARE
CO0694280OtherAETNA
WY1192523-00Medicaid
COD8004OtherMEDICARE PART B
CO=========11OtherPACIFICARE
COB001OtherTRICARE WPS
CODE0901OtherRAILROAD MEDICARE
WY1192523-00Medicaid
CO81933762Medicaid