1538354568 NPI number — THE LITTLE CLINIC OF COLORADO, LLC

Table of content: (NPI 1538354568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538354568 NPI number — THE LITTLE CLINIC OF COLORADO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LITTLE CLINIC OF COLORADO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538354568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 932958
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-425-4200
Provider Business Mailing Address Fax Number:
615-891-5244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9551 S UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLANDS RANCH
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-459-5639
Provider Business Practice Location Address Fax Number:
303-459-5640
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WATKINS
Authorized Official First Name:
MARC
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
615-425-4200

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9000165041 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165045 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165039 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165040 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165174 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165407 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165586 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165173 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165438 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165064 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165171 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165042 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165226 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165350 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165847 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165196 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165227 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165406 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165038 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000165165 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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