Provider Demographics
NPI:1447322755
Name:LITTLETON ORTHOPAEDIC ASSOCIATES PC
Entity type:Organization
Organization Name:LITTLETON ORTHOPAEDIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-798-8107
Mailing Address - Street 1:7720 S BROADWAY
Mailing Address - Street 2:#210
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2632
Mailing Address - Country:US
Mailing Address - Phone:303-798-8107
Mailing Address - Fax:303-798-1756
Practice Address - Street 1:7720 S BROADWAY
Practice Address - Street 2:#210
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2624
Practice Address - Country:US
Practice Address - Phone:303-798-8107
Practice Address - Fax:303-798-1756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLIB5208OtherBLUE SHIELD
CO029690001OtherPALMETTO
COCD6323OtherRAILROAD MEDICARE
CO04005161Medicaid
COLIB5208OtherBLUE SHIELD
CO04005161Medicaid