Basic Information
| Provider Information | |||||||||
| NPI: | 1245854470 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLATTE VALLEY MEDICAL GROUP, LLC | ||||||||
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| OtherOrganizationName: | PLATTE VALLEY MEDICAL GROUP - ORTHOPEDICS BRIGHTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 PRAIRIE CENTER PKWY STE 2200 | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806014008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034981885 | ||||||||
| FaxNumber: | 3034981884 | ||||||||
| Practice Location | |||||||||
| Address1: | 1610 PRAIRIE CENTER PKWY STE 2200 | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806014008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034981885 | ||||||||
| FaxNumber: | 3034981884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2020 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCDANIEL | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3032720231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BRIGHTON COMMUNITY HOSPITAL ASSOCIATION | ||||||||
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| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.